Provider Relations Representative jobs in Portland, OR

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)

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Provider Relations Representative II
  • Moda Health
  • Portland, OR FULL_TIME
  • Let’s do great things, together

    Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

    Provide exceptional customer service to contracted providers by being the liaison between the contracted provider and the Health Plan. The Provider Relations Representative is responsible for presenting, promoting, and resolving concerns and issues brought forward by the providers or the Health Plan.

    This is a Hybrid role for the Portland Metro Area.

    Please fill out an application on our company page, linked below, to be considered for this position.

    • https://j.brt.mv/jb.do?reqGK=27714768&refresh=true
    Benefits:
    • Medical, Dental, Pharmacy, and Vision Coverage
    • 401K
    • FSA
    • PTO and Paid Holidays
    Required Skills, Experience, & Education:
    • College degree or equivalent work experience in the health insurance industry
    • 2-4 years’ experience as a Provider Relations Rep with a Health Plan or 2-4 years’ experience as a Provider Relations Rep I with Moda.
    • Strong facilitation skills with an ability to run provider meetings with prioritized specific topic agendas reflecting entire provider support.
    • Strong relationship building skills.
    • Demonstrated strong verbal, written, and interpersonal communication skills.
    • Possess analytical, problem-solving, and attention-to-detail skills.
    • Knowledge of medical insurance reimbursement methodologies including but not limited to DRG and APC pricing.
    • PC proficiency, preferably with Microsoft Word and Excel and FACETS.
    • Ability to work well under pressure, work with frequent interruptions and shifting priorities.
    • Maintain confidentiality and project a professional business image.
    • Identify root causes of claim problems and trends while participating in the development of potential solutions.
    • Strong ability to work within a team environment as well as independently.

    Primary Functions:
    • Identify root cause of claims problems, trends, and participate in developing solutions. This includes performing research through available systems, policies and departments ensuring timely resolution.
    • Develop and review Dashboard metrics (quality, financial, triple AIM) and translate into actionable items based on group specifics.
    • Ability to provide actionable financial and operational data and to ensure action plans are implemented to achieve performance goals.
    • Work in a consultative role with various departments locally creating effective information and analyses to optimize the market’s strategic objectives for providers.
    • Provide timely responses to all provider inquiries, within in three business days.
    • Conduct regular on-site provider visits to create strategic provider partnerships to improve health efficiencies, and foster provider experience while ensuring cohesion across product lines with Moda’s policies. All providers should be provided with an invitation for such on-site visits. There should be a minimum of 36 visits on average per year (three per month).
    • Educate providers on their health plan contract language ensuring consistent interpretation.
    • Organize, prepare, and present annual Provider Workshops. Workshops are our opportunity to foster relationships, provide education and represent Moda in a positive light.
    • Participate in ongoing Moda committees with the expectation of providing feedback and recommendations from the Provider Relations perspective while bringing back pertinent information.
    • Utilize necessary resources, tools and navigate systems efficiently to provide accurate and timely responses to inquiries
    • Represent Moda in a positive and professional manner at all times.
    • Collaborate with other teams, peers, and management to identify areas of inefficiency and process improvement opportunities.
    • Other duties as assigned

    Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

    For more information regarding accommodations please direct your questions to hradmin@modahealth.com.

  • 4 Days Ago

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Health Plan Provider Relations Representative II
  • Moda Health
  • Portland, OR FULL_TIME
  • Let’s do great things, together ​​​​​Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healt...
  • 23 Days Ago

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HS Provider Relations Coordinator
  • Oregon Health & Science University
  • Portland, OR OTHER
  • Department Overview *** Available for Remote Work *** OHSU Health IDS/THPS is committed to the ongoing journey of being an anti-racist organization that acknowledges the enduring impacts of historical...
  • 22 Days Ago

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Provider Relations Assistant *Remote
  • Providence
  • Beaverton, OR OTHER
  • DescriptionProvidence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitmen...
  • 10 Days Ago

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Provider Relations Assistant *Remote
  • Providence
  • Portland, OR OTHER
  • DescriptionProvidence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitmen...
  • 10 Days Ago

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Customer Relations Representative - Portland
  • Baker Commodities, Inc.
  • Portland, OR FULL_TIME
  • Job Purpose Procures new business and maintains existing customer base. Duties and Responsibilities Responsible for soliciting new business and maintaining the existing customer base. This will includ...
  • 1 Month Ago

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0 Provider Relations Representative jobs found in Portland, OR area

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Customer Relations Representative
  • Standard Appliance, Inc.
  • Portland, OR
  • at least 1 year Then come work with us! Standard TV and Appliance has an opening for a CUSTOMER RELATIONS REPRESENTATIVE...
  • 3/29/2024 12:00:00 AM

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Seasonal Customer Service Representative PDX Airport
  • Enterprise Holdings
  • Portland, OR
  • Overview: Enterprise Rent-A-Car at the Portland International Airport is looking to grow our Customer Service Representa...
  • 3/28/2024 12:00:00 AM

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Local Success Coach (Part Time Sales & Customer Service Coordinator)
  • GOAUPAIR OPERATIONS LLC
  • Portland, OR
  • Job Description Job Description Work from home as part-time Local Success Coach (LSC)! Great part-time position for anyo...
  • 3/27/2024 12:00:00 AM

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FT Customer Service Representative - Work From Home>
  • Dick's Sporting Goods, Inc.
  • Lake Oswego, OR
  • [Customer Support / Remote] - Anywhere in U.S. / Up to $46.2K per year / Benefits - As a Customer Service Rep you'll: As...
  • 3/27/2024 12:00:00 AM

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Parts & Inventory - Service Support Representative
  • Altec Industries, Inc.
  • Portland, OR
  • Responsibilities The Altec Service Group has service centers and an extensive fleet of mobile service vehicles and te...
  • 3/26/2024 12:00:00 AM

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Parts & Inventory - Service Support Representative
  • Altec Industries , Inc.
  • Portland, OR
  • Responsibilities The Altec Service Group has service centers and an extensive fleet of mobile service vehicles and techn...
  • 3/26/2024 12:00:00 AM

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Pharmacy Customer Care Representative I
  • Res-Care, Inc.
  • Vancouver, WA
  • Our Company PharMerica Overview Pharmacy Technician License Fees: We've Got You Covered! New hires and current employees...
  • 3/26/2024 12:00:00 AM

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Client Representative
  • Summit Strive Consulting
  • Portland, OR
  • Job Description Job Description Job Title: Client Representative Company Overview: Join our passionate team dedicated to...
  • 3/25/2024 12:00:00 AM

Portland is the largest and most populous city in the U.S. state of Oregon and the seat of Multnomah County. It is a major port in the Willamette Valley region of the Pacific Northwest, at the confluence of the Willamette and Columbia rivers. As of 2017, Portland had an estimated population of 647,805, making it the 26th-largest city in the United States, and the second-most populous in the Pacific Northwest (after Seattle). Approximately 2.4 million people live in the Portland metropolitan statistical area (MSA), making it the 25th most populous MSA in the United States. Its Combined Statist...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative jobs
$55,679 to $71,230
Portland, Oregon area prices
were up 3.9% from a year ago