Provider Relations Representative supports, develops and maintains service relationships with all participants (physicians, providers and administrators) of a provider network. Responds to electronic and direct inquiries from clients about policies, rates, changes, referrals, eligibility, credentialing, etc. Typically requires a bachelor's degree. Being a Provider Relations Representative typically reports to a supervisor or manager. The Provider Relations Representative works on projects/matters of limited complexity in a support role. Work is closely managed. To be a Provider Relations Representative typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)
Position Description: Paralegal - Health Insurance Specialist
Under the direction of the Independent Dispute Resolution Entity (IDRE) Stakeholder Engagement Subject Matter Expert or his/her designee, the Paralegal - Health Insurance Specialist applies critical thinking skills, IDRE program policies and regulatory guidance to analyze and adjudicate payment determination disputes between nonparticipating providers, nonparticipating emergency facilities or nonparticipating providers of air ambulance services and a group health plan. The Paralegal - Health Insurance Specialist reviews all documentation received from the involved parties in regard to their proposed payment amount and renders an independent determination, selecting one of the two proposed offers, based upon the credible facts presented. The Paralegal ? Health Insurance Specialist will specialize in processing bifurcated state disputes and will complete research on state laws in support of attorneys as requested/required. .In addition to review, the Health Insurance Specialist completes all case related documentation and sends appropriate email notification as per the established workflow. They are also responsible for timely and accurate case specific data entry into the government portal.
Responsibilities:
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0 Provider Relations Representative jobs found in El Paso, TX area