Provider Relations Representative, Sr. jobs in Fairfield, CA

Provider Relations Representative, Sr. 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. May provide guidance or expertise to less experienced representatives. Being a Provider Relations Representative, Sr. typically requires a bachelor's degree. Typically reports to a supervisor or manager. The Provider Relations Representative, Sr. gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Relations Representative, Sr. typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

P
Provider Relations Representative I
  • Partnership HealthPlan of California
  • Fairfield, CA FULL_TIME
  • Overview

    To establish and maintain excellent relationships with the provider network in a specific geographic region, including healthcare practitioners, office staff, and administrators. Works closely to identify and resolve complex issues, provides education and staff training. Provides service and education via onsite visits and telephone. Assists providers with understanding Partnership HealthPlan of California's policies and procedures and assists with resolving issues that arise.

    Responsibilities

    • Maintains regular schedule of provider office visits to ensure open lines of communication, answers questions, distributes information, and documents and follows-up on questions or concerns. Ensures each visit includes a well-documented Rep Visit Sheet.
    • Investigates and responds to provider concerns. Serves as neutral liaison between providers and PHC departments in responding to questions and resolving issues. Assists with research and disposition of provider appeals and grievances.
    • Trains provider offices via onsite visits and by telephone regarding PHC policies, procedures, and available resources.
    • Creates educational materials and formal presentations.
    • Conducts provider orientations and ongoing educational training sessions. Assists with meeting coordination to ensure agendas are distributed timely and materials and other required arrangements are prepared.
    • Educates providers on the use of PHC provider information forms. Follows up with providers on incomplete forms to obtain required information.
    • Resolve complex authorization or claims issues. Identify potential system issues, collaborate with affected departments to ensure resolution.
    • Conducts monthly, quarterly, annual and ad hoc provider surveys.
    • Creates Corrective Action Plans (CAPS) for provider sites that did not meet standards. Monitors compliance with CAP.  
    • Uses databases and tracking systems to document and retrieve information and run reports.
    • Composes correspondence, conducts research, and prepares reports.
    • Coordinates, attends, and participates in various meetings both on and off-site as assigned.
    • May be required to report on major points, resolved and pending action items.
    • Required to work with minimal supervision.
    • Other duties as assigned.          

    Qualifications

    Education and Experience

    Bachelor’s degree in health care administration, business, or public relations preferred, or equivalent combination of education and experience; prior experience with physician offices or managed care or health insurance environment preferred.

     

    Special Skills,

    Licenses and

    Certifications

    Excellent oral and written communication and presentation skills. Excellent organizational, prioritizing, and multi-tasking skills required. Ability to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy. Proficient in Microsoft Office (Word, PowerPoint, Excel). Ability to use a variety of databases for research and entry of information. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.

     

     

     

     

    Performance

    Based

    Competencies

     

     

     

    Must be able to work in a fast-paced environment and maintain  courtesy and composure. Ability to function effectively with frequent interruptions.

     

     

    Work Environment

    And Physical

    Demands

    At least 50% of work time is spent driving and more than 30% of work time is spent in front of a computer monitor. Ability to lift, carry or move objects of varying size, weighing up to 25 lbs.  

     

     

    All HealthPlan employees are expected to:

    • Provide the highest possible level of service to clients;
    • Promote teamwork and cooperative effort among employees;
    • Maintain safe practices; and
    • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

     HIRING RANGE:

     

    $ 59,560.74 - $ 77,427.93

     

    IMPORTANT DISCLAIMER NOTICE                                                                                                                           

     

    The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

     

     

     

  • 2 Months Ago

C
Customer Relations Representative
  • California Lifestyle Foundation
  • Vacaville, CA FULL_TIME
  • Are 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 looki...
  • Just Posted

S
Guest Relations Representative
  • Six Flags Discovery Kingdom
  • Vallejo, CA FULL_TIME
  • Enjoy the perks of being a Six Flags Team member Get free admission to all Six Flags Theme Parks, free tickets for friends and family, access to exclusive employee events, and discounts. Responsible f...
  • 2 Days Ago

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Labor Relations Representative - Ukiah
  • CALIFORNIA SCHOOL EMPLOYEES ASSOCIATION
  • Concord, CA OTHER
  • Job Details Job Location: North Bay Field Office - Concord, CA Position Type: Full Time Salary Range: $78,043.00 - $113,528.00 Salary/year Travel Percentage: Road Warrior Job Category: Field Operation...
  • 9 Days Ago

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Labor Relations Representative - Eureka
  • CALIFORNIA SCHOOL EMPLOYEES ASSOCIATION
  • Concord, CA OTHER
  • Job Details Job Location: North Bay Field Office - Concord, CA Position Type: Full Time Salary Range: $78,043.00 - $113,528.00 Salary/year Travel Percentage: Road Warrior Job Category: Field Operation...
  • 12 Days Ago

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Customer Relations Representative
  • California Lifestyle Foundation
  • Vallejo, CA FULL_TIME
  • Are 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 looki...
  • 13 Days Ago

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0 Provider Relations Representative, Sr. jobs found in Fairfield, CA area

C
Customer Relations Representative
  • California Lifestyle Foundation
  • Concord, CA
  • Are you a dedicated, self-driven individual with a passion for providing outstanding customer support? Do you have a rep...
  • 3/28/2024 12:00:00 AM

3
Customer Relations Representative
  • 3rd Degree Solutions
  • Elk Grove, CA
  • 3rd Degree Solutions is a fast-paced customer acquisition company dedicated to helping our clients expand their customer...
  • 3/28/2024 12:00:00 AM

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House Attendant
  • Residence Inn Vacaville
  • Vacaville, CA
  • Compensation Type: Hourly Highgate Hotels: Highgate is a premier real estate investment and hospitality management compa...
  • 3/27/2024 12:00:00 AM

E
Call Center Pt. Servc. Rep
  • E-Talent Network
  • Fairfield, CA
  • Skills: Registration and Charge Entry 1. Gathers, updates and verifies a comprehensive package of registration and insur...
  • 3/27/2024 12:00:00 AM

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FT Customer Service Representative - Work From Home>
  • Dick's Sporting Goods, Inc.
  • Vacaville, CA
  • [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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Area Service Representative
  • Rug Doctor, LLC
  • Vacaville, CA
  • ** Area Service Representative** **Job Category****:** Operations **Requisition Number****:** AREAS001250 Showing 1 loca...
  • 3/27/2024 12:00:00 AM

D
FT Customer Service Representative - Work From Home>
  • Dick's Sporting Goods, Inc.
  • Vallejo, CA
  • [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

A
Delivery Driver - Patient Service Technician - CMV
  • Apria
  • Fairfield, CA
  • At Owens & Minor, we are a critical part of the healthcare process. As a Fortune 500 company with 50+ facilities across ...
  • 3/26/2024 12:00:00 AM

Fairfield is a city in, and the county seat of, Solano County, California, in the North Bay sub-region of the San Francisco Bay Area. It is generally considered the midpoint between the cities of San Francisco and Sacramento, approximately 40 miles (64 km) from the city center of both cities, approximately 40 miles (64 km) from the city center of Oakland, less than 19 miles (31 km) from Napa Valley, 16 miles (26 km) from the Carquinez Bridge, and 14 miles (23 km) from the Benicia Bridge. Fairfield was founded in 1856 by clippership captain Robert H. Waterman, and named after his former hometow...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$80,048 to $99,269
Fairfield, California area prices
were up 2.5% from a year ago

Provider Relations Representative, Sr. in Kingsport, TN
A job as a Provider Relations Representative falls under the broader career category of Business Operations Specialists, All Other.
February 18, 2020
Provider Relations Representative, Sr. in Sioux City, IA
The PR Rep serves as a liaison between contracted payers, providers and ancillary providers to promote superior customer service and seamless programs.
February 16, 2020
Provides telephonic provider education to new providers.
February 14, 2020
Provider Relations Representative, Sr. in Buffalo, NY
This position provides on-going communication, in-service, orientation, and direction to these contracted provider offices.
February 03, 2020