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)
Your Role
The Provider Support team for Claims and Payment Models is a specialized unit within the Network Management and Provider Partnerships organization that is accountable for improving the provider experience and streamlining operations. The Provider Relations Representative, Consultant will report to the Senior Manager. In this role you will be responsible for assisting providers including Facilities, Large Systems, and Physicians contracted for value-based payment models with escalated claims and payment issues. Internally, you will be responsible for partnering with cross functional teams including Provider Relations, Contracting, Claims, Clinical, Legal & Compliance, Data Analytics, Information Technology, and Innovation to facilitate issue resolution, identify root causes, and deliver operational improvements.
Your Work
In this role, you will:
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0 Provider Relations Representative jobs found in Torrance, CA area