Provider Relations Representative, Sr. jobs in Oklahoma City, OK

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)

A
Provider Relations Manager
  • Absentee Shawnee Tribe of Indians of Oklahoma
  • Norman, OK FULL_TIME
  • This position is currently open.

    Public?:
    Internal
    Division:
    Health
    Reports To:
    Medical Director
    Type of Position:
    Regular Full Time
    Location:
    Little Axe Health Center / 15951 Little Axe Dr. / Norman, OK 73026
    General Description
    Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all practitioners who provide patient care within the Absentee Shawnee Tribal Health System. Responsible for ensuring practitioners are credentialed, appointed and privileged with health plans. Maintain up-to-date data for each practitioner in online credentialing data base and practice management system for billing; ensure timely renewal of licenses and certifications. Partial oversite of Credentialing Specialist.
    Responsibilities
    Processing initial credentialing and re-credentialing applications
    Screening practitioners’ applications and supporting documentation to ascertain their eligibility
    Collecting information from the National Practitioner Data Bank (NPDB), the applicant and their malpractice insurer
    Collecting primary source credentialing and privileging verification, via AMA, AOA, ECFMG, OIG Exclusions List, Licensing Board, DEA and OBNDD verification, National Student Clearinghouse, Board Certifications
    Identifying discrepancies in information and conducting follow up
    Assist Credentialing Specialist to present completed initial and re-appointment credentialing applications to the Credentialing Committee
    Present completed initial and re-appointment credentialing applications at monthly Health Board Meeting
    Distribution, research and working knowledge of Medical Staff Bylaws, Rules and Regulations. Assist with the development of the Medical Staff Bylaws, policies, procedures, rules and regulations to ensure that the medical staff is aware of changes.
    Prepare reports, letters and other confidential materials
    Track, validate expiring licensure, DEA certificates, OBNDD, malpractice coverage and any other required credentialing documents for all practitioners to ensure timely renewals
    Auditing Medical Staff Credentialing files
    Responding to health plan provider inquires
    Maintains knowledge of current health plan and agency requirements for credentialing practitioners
    Sets up and maintain practitioner Medical Staff Appointment/Re-Appointment files in online credentialing data base and practice management system
    Ensures practice addresses are current with health plans, agencies and other entities
    Audits health plan directories for current and accurate provider information
    Maintains confidentiality of practitioner information
    Edit or amend contracts and handle terms of contract breach
    Prepare, review and evaluate contracts for compliance of legality and for profitability if applicable
    Negotiate insurance contract terms and reimbursement rates on an annual bases
    Assist Medical Director with monthly practitioner meetings; Journal Club monthly meeting; OSMA CME monthly training; OSMA practitioner yearly CME event
    Assist Medical Director/Health Attorney with provider employment agreements
    Assist Credentialing Specialist/Deputy Director with peer review and maintaining confidential folders
    Track, audit, review and maintain credentialing hold claim status, add insurance effective dates within eClinicalWorks practice management system
    Assist Medical Director/Deputy Medical Director as needed
    Practitioner time clock, tracking vacation/sick leave
    Maintaining bi-monthly provider meetings, agendas and monthly notes
    Track, complete and maintain insurance contracts for CompleteCare Home Health
    Track and maintain practitioner CME budget
    Submit reimbursements for licensure, membership, subscriptions and book orders through Microix
    Coordinate with the Travel Specialist/Medical Director regarding practitioner travel/training
    Coordinate student schedules with HR, Medical Director, Deputy Medical Director and all other departments as directed
    Coordinate the onboarding process with HR, EHR, and Administration for new hire practitioners
    DIA system access form and Provider digital signature forms collected and completed to assist EHR
    Maintain partial oversite for the Credentialing Specialist
    Knowledge and understanding of the credentialing and privileging to maintain AAAHC Accreditation
    Ability to organize and prioritize work and manage multiple priorities
    Ability to work independently with minimal supervision
    Performs other duties as assigned
    Education Requirements and Qualifications
    Required Qualifications:
    Education: High School Diploma / Some College Preferred
    10 years of previous credentialing experience within a healthcare environment preferred
    Knowledge and understanding of the credentialing process
    Ability to organize and prioritize work and manage multiple priorities
    Excellent verbal and written communication skills including, letters, memos and emails
    Excellent attention to detail
    Ability to research and analyze data
    Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization
    Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources
    Preferred Qualifications:
    Associate degree / Certified Provider Credentialing Specialist (CPCS) / Certified Professional Medical Services Management (CPMSM)
    Previous experience working with a Native American entity.
    Physical Requirements and Working Conditions
    Must be able to sit, stand, stoop, bend or kneel for long periods of time.
    Sitting or standing or walking for long period of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking hearing and visual acuity.
    Frequent lifting (up to 15 lbs)
    Occasional lifting (up to 30 lbs)
    Native American Preference/EEO/Drug Free Workplace/Smoke Free Workplace
    Posted Date:
    1 day 23 hours ago
    Closing Date:
    Saturday, November 18, 2023


    Tribal Preference/Native American Preference/EEO/Smoke Free/Drug Free Workplace
    Indian preference applies to all positions, but all resumes will be accepted.


    Forward Completed Absentee Shawnee Tribe applications with resume to:
    Absentee Shawnee Tribe
    Human Resources Department
    2025 South Gordon Cooper Dr.
    Shawnee, OK 74801
    Fax: 405-273-2710
    Email: HR@astribe.com

  • 10 Days Ago

E
Customer Relations Representative
  • Elite Lawn Care
  • Oklahoma, OK FULL_TIME
  • Elite Lawn Care OKAre you passionate about providing exceptional customer experiences? Do you enjoy working in a fast-paced environment? Elite Lawn Care OK is seeking a dynamic and customer-oriented i...
  • 10 Days Ago

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Client Relations Representative
  • BairesDev
  • Oklahoma, OK FULL_TIME
  • BairesDev is the leading software development company in the Americas. With more than 1300 employees working on projects around the world, a sustained average annual growth of over 50%, and recognized...
  • 12 Days Ago

D
Client Relations Representative – Group Setup
  • Delta Dental of Oklahoma
  • Oklahoma, OK FULL_TIME
  • Join Delta Dental of Oklahoma, the leading dental benefits provider in the state of Oklahoma. This position will work 40 hours per week. Equal Opportunity Employer - Minority/Female/Disability/Veteran...
  • 8 Days Ago

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Client Relations Representative – Group Setup
  • Delta Dental of Oklahoma
  • Oklahoma, OK FULL_TIME
  • Join Delta Dental of Oklahoma, the leading dental benefits provider in the state of Oklahoma. This position will work 40 hours per week. Equal Opportunity Employer - Minority/Female/Disability/Veteran...
  • 11 Days Ago

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Customer Relations Representative - State Farm Agent Team Member
  • Bobby Lewis - State Farm Agent
  • Midwest, OK FULL_TIME
  • Position Overview Are you outgoing and customer-focused? Do you enjoy working with the public? If you answered yes to these questions, working for a State Farm independent contractor agent may be the ...
  • 19 Days Ago

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0 Provider Relations Representative, Sr. jobs found in Oklahoma City, OK area

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Sr. Director Growth, Cloud Professional Services (REMOTE)
  • Acxiom LLC
  • Oklahoma City, OK
  • Acxiom is currently seeking sales professionals to join our expanding cloud services organization. In this role, you wil...
  • 3/29/2024 12:00:00 AM

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Work from Home Customer Service Representative - Oklahoma McKinney, Texas US (13837)
  • Globe Life Inc.
  • Oklahoma City, OK
  • **Work from Home Customer Service Representative - Oklahoma** McKinney, Texas, US Job number: 13837 **Job Description:**...
  • 3/29/2024 12:00:00 AM

A
Customer Service Representative
  • Acme Brick Company
  • Oklahoma City, OK
  • **Customer Service Representative** City **Oklahoma City** State/Territory **US-OK** Employment Type **Full time** **Joi...
  • 3/29/2024 12:00:00 AM

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Customer Service Representative | OK | Oklahoma City | 16 Feb 2022
  • CARSTAR Franchising, Inc.
  • Oklahoma City, OK
  • **Customer Service Representative CARSTAR Jeremiah's Collision, OK 73114** **JOB SUMMARY** The Customer Service Represen...
  • 3/28/2024 12:00:00 AM

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Customer Service Representative | OK | Oklahoma City | 22 Oct 2021
  • CARSTAR Franchising, Inc.
  • Oklahoma City, OK
  • Customer Service Representative **Customer Service Representative - CARSTAR Jeremiah's Collision** **JOB SUMMARY** The C...
  • 3/28/2024 12:00:00 AM

C
Customer Service Representative | OK | Oklahoma City | 02 Dec 2021
  • CARSTAR Franchising, Inc.
  • Oklahoma City, OK
  • Customer Service Representative **Customer Service Representative - CARSTAR Jeremiah's Collision** **JOB SUMMARY** The C...
  • 3/28/2024 12:00:00 AM

C
Customer Service Representative | OK | Oklahoma City | 27 Nov 2021
  • CARSTAR Franchising, Inc.
  • Oklahoma City, OK
  • Customer Service Representative **Customer Service Representative - CARSTAR Jeremiah's Collision** **JOB SUMMARY** The C...
  • 3/28/2024 12:00:00 AM

C
Customer Service Representative | OK | Oklahoma City | 25 Nov 2021
  • CARSTAR Franchising, Inc.
  • Oklahoma City, OK
  • Customer Service Representative **Customer Service Representative - CARSTAR Jeremiah's Collision** **JOB SUMMARY** The C...
  • 3/28/2024 12:00:00 AM

Oklahoma City lies along one of the primary corridors into Texas and Mexico, and is a three-hour drive from the Dallas-Fort Worth metroplex. The city is in the Frontier Country region in the center of the state, making it an ideal location for state government. According to the United States Census Bureau, the city has a total area of 620.34 square miles (1,606.7 km2), of which 601.11 square miles (1,556.9 km2) is land and 19.23 square miles (49.8 km2) is water. Oklahoma City lies in the Sandstone Hills region of Oklahoma, known for hills of 250 to 400 feet (120 m) and two species of oak: blac...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$65,184 to $80,837
Oklahoma City, Oklahoma area prices
were up 1.2% from a year ago

Provider Relations Representative, Sr. in Kingsport, TN
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