Provider Relations Representative
3 weeks ago
POSITION SUMMARY:
The purpose of this position is to analyze assigned existing market needs, performs some standard contracting functions, educates providers and provider service entities, maintain business relationships for the Health Plan(s), reports on provider and market changes, acts as a support for other service areas for the Health Plan(s).
ESSENTIAL FUNCTIONS:To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation
•Contracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members
•Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines
•Educating providers on the Health Plan(s) functions and roles in caring for its membership
•Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies
•To conduct the education presentations of the Health Plan(s) providers to insure their understanding and commitment with the Health Plan(s)
•Monitor, maintain and support provider relationships to insure network coverage in all areas
•To work with and be involved in implementation as needed
•Establish a positive work environment that encourages participation in process improvement and commitment to department/company success
•Complete corporate assignments as assigned
Required Skills:
•Must be fluent in all current provider payment methodologies including per diems, DRGs, and APCs
•Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships
•Must be able to accept instructions and work independently in the completions of goals and assignments
•Must have strong negotiation, organization, presentation and time management skills
•Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goals
•Must be able to work effectively in a team environment
•Excellent computer skills, including Microsoft Office Suite
•Must be self-motivated, dependable, team and goal-oriented
Required Work Experience:
•Experience in the health care field required
•Prior experience in network development / network services is preferred
•Prior experience with acute and post-acute facilities is beneficial
•Prior experience with Medicare Advantage plans is helpful
Licensing/Certification/Education Requirements:
•Bachelor's degree preferred, but not required, with emphasis in Healthcare Administration/related field or three (3) years of experience in managed care network development/network services
Other Requirements:
•Must be available to work 8 a.m. until 5 p.m. local time
•Position requires travel to network provider locations.
•Teleworking is an option if criteria are met
Required Computer Software/Equipment Used:
•Microsoft Suite including Outlook, Excel, and Word
•Standard Office Equipment
•Computer
Physical Requirements:
•Allows discretion for standing, walking, sitting
•Work is performed in a standard office environment; well-lit; comfortable temperature controlled; average conversational noise is frequent
•The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
Required Safety Expectations:
•Working safely and follow safety rules
•Report unsafe working conditions and behaviors
•Take reasonable and prudent actions to prevent others from engaging in unsafe practices
Supervisory Responsibilities:
•Does not have direct supervisory responsibilities
•Supervisor frequently determines priorities
•Occasionally needs manager's direction due to extraordinary circumstances
-
Customer Relations Representative
3 weeks ago
Baton Rouge, United States LMI Baton Rouge Full timeAre you a dedicated, self-driven individual with a passion for providing outstanding customer support? Do you have a reputation for consistently prioritizing customer satisfaction? If so, we are looking for you to join our team as a Customer Relations Representative. Our mission is to foster positive relationships with our customers and donors, educating...
-
Customer Relations Representative
3 weeks ago
Baton Rouge, United States LMI Baton Rouge Full timeJob DescriptionJob DescriptionAre you a dedicated, self-driven individual with a passion for providing outstanding customer support? Do you have a reputation for consistently prioritizing customer satisfaction? If so, we are looking for you to join our team as a Customer Relations Representative. Our mission is to foster positive relationships with our...
-
Customer Relations Representative
2 weeks ago
Baton Rouge, United States LMI Baton Rouge Full timeJob DescriptionJob DescriptionAre you a dedicated, self-driven individual with a passion for providing outstanding customer support? Do you have a reputation for consistently prioritizing customer satisfaction? If so, we are looking for you to join our team as a Customer Relations Representative. Our mission is to foster positive relationships with our...
-
Customer Relations Representative
6 days ago
Baton Rouge, United States LMI Baton Rouge Full timeJob DescriptionJob DescriptionAre you a dedicated, self-driven individual with a passion for providing outstanding customer support? Do you have a reputation for consistently prioritizing customer satisfaction? If so, we are looking for you to join our team as a Customer Relations Representative. Our mission is to foster positive relationships with our...
-
Customer Relations Representative
2 days ago
Baton Rouge, United States LMI Baton Rouge Full timeJob DescriptionJob DescriptionAre you a dedicated, self-driven individual with a passion for providing outstanding customer support? Do you have a reputation for consistently prioritizing customer satisfaction? If so, we are looking for you to join our team as a Customer Relations Representative. Our mission is to foster positive relationships with our...
-
Provider Relations Specialist
4 weeks ago
Baton Rouge, United States Baton Rouge General Full timeDescriptionRoles & ResponsibilitiesThe Provider Relations Specialist is an integral member of the Verity Network and operations development teams. The person selected for this role is responsible to deliver industry leading service to physicians, providers, practice managers, and/or ancillaries within the provider networks.Additionally, this person will be...
-
Provider Relations Specialist
4 days ago
Baton Rouge, United States Baton Rouge General Full timeDescription Roles & Responsibilities The Provider Relations Specialist is an integral member of the Verity Network and operations development teams. The person selected for this role is responsible to deliver industry leading service to physicians, providers, practice managers, and/or ancillaries within the provider networks.Additionally, this person will be...
-
Provider Relations Specialist
4 weeks ago
Baton Rouge, United States CareerArc Full timeRoles & Responsibilities The Provider Relations Specialist is an integral member of the Verity Network and operations development teams. The person selected for this role is responsible to deliver industry leading service to physicians, providers, practice managers, and/or ancillaries within the provider networks. Additionally, this person will be...
-
Provider Relations Specialist
1 day ago
Baton Rouge, United States Baton Rouge General Full timeDescription Roles & Responsibilities The Provider Relations Specialist is an integral member of the Verity Network and operations development teams. The person selected for this role is responsible to deliver industry leading service to physicians, providers, practice managers, and/or ancillaries within the provider networks.Additionally, this person will be...
-
Provider Relations Specialist
1 day ago
Baton Rouge, United States CareerArc Full timeRoles & Responsibilities The Provider Relations Specialist is an integral member of the Verity Network and operations development teams. The person selected for this role is responsible to deliver industry leading service to physicians, providers, practice managers, and/or ancillaries within the provider networks. Additionally, this person will be...
-
Provider Relations Specialist
3 weeks ago
Baton Rouge, United States Baton Rouge General Full timeDescription Roles & Responsibilities The Provider Relations Specialist is an integral member of the Verity Network and operations development teams. The person selected for this role is responsible to deliver industry leading service to physicians, providers, practice managers, and/or ancillaries within the provider networks.Additionally, this person will be...
-
Customer Relations Representative
1 week ago
Baton Rouge, United States Steven Brooksher - State Farm Agent Full timeJob DescriptionJob DescriptionPosition OverviewSuccessful State Farm Agent is seeking a qualified professional to join their winning team for the role of Customer Relations Representative - State Farm Agent Team Member. We seek an energetic professional interested in helping our business grow through value-based conversations and remarkable customer...
-
Provider Dispute Specialist
1 week ago
Baton Rouge, United States Bcbsla Full timeBlue Cross and Blue Shield of Louisiana Jobs Blue Cross and Blue Shield of Louisiana Provider Dispute Specialist in Baton Rouge , Louisiana We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with...
-
HIP Customer Relations Coordinator
4 weeks ago
Baton Rouge, United States HAART Inc Full timeJob Purpose: The Health Insurance Program Customer Relations Coordinator performs a variety of functions; such as face-to-face contact with clients, assisting clients with applications and insurance needs, researching premiums for bookkeepers, communicating directly with Health Insurance Program Coordinator to resolve any client issues, and...
-
Provider Dispute Specialist
2 weeks ago
Baton Rouge, United States Bcbsla Full timeBlue Cross and Blue Shield of Louisiana Jobs Blue Cross and Blue Shield of Louisiana Provider Dispute Specialist in Baton Rouge , Louisiana We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with...
-
Provider Dispute Specialist
1 week ago
Baton Rouge, United States Blue Cross and Blue Shield of Louisiana Full timeBlue Cross and Blue Shield of Louisiana Provider Dispute Specialist Baton Rouge , Louisiana Apply Now We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross. Residency in or relocation...
-
HIP Customer Relations Coordinator
2 weeks ago
Baton Rouge, United States Open Health Care Clinic Full timeJob DescriptionJob DescriptionJob Purpose:The Health Insurance Program Customer Relations Coordinator performs a variety of functions; such as face-to-face contact with clients, assisting clients with applications and insurance needs, researching premiums for bookkeepers, communicating directly with Health Insurance Program Coordinator to resolve any client...
-
HIP Customer Relations Coordinator
4 weeks ago
Baton Rouge, United States Open Health Care Clinic Full timeJob DescriptionJob DescriptionJob Purpose:The Health Insurance Program Customer Relations Coordinator performs a variety of functions; such as face-to-face contact with clients, assisting clients with applications and insurance needs, researching premiums for bookkeepers, communicating directly with Health Insurance Program Coordinator to resolve any client...
-
HIP Customer Relations Coordinator
3 weeks ago
Baton Rouge, United States Open Health Care Clinic Full timeJob DescriptionJob DescriptionJob Purpose:The Health Insurance Program Customer Relations Coordinator performs a variety of functions; such as face-to-face contact with clients, assisting clients with applications and insurance needs, researching premiums for bookkeepers, communicating directly with Health Insurance Program Coordinator to resolve any client...
-
HIP Customer Relations Coordinator
1 day ago
Baton Rouge, United States Open Health Care Clinic Full timeJob DescriptionJob DescriptionJob Purpose:The Health Insurance Program Customer Relations Coordinator performs a variety of functions; such as face-to-face contact with clients, assisting clients with applications and insurance needs, researching premiums for bookkeepers, communicating directly with Health Insurance Program Coordinator to resolve any client...