Provider Relations Representative jobs in Albany, NY

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)

C
Provider Service Representative
  • CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC
  • Albany, NY FULL_TIME
  •  
     
    CDPHP and its family of companies are mission-driven organizations that support the health and well-being of our customers and the communities we are proud to serve. CDPHP was founded in Albany in 1984 as a physician-guided not-for-profit, and currently offers health plans in 29 counties in New York state. The company values integrity, diversity, and innovation, and its corporate culture supports those values wholeheartedly. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.

    The Provider Services Representative shall assume full responsibility and ownership for all aspects regarding education of the providers, practitioners, facilities, adjunct/ancillary and all other providers regarding the proper utilization of the Plan. In addition, the representative will address and resolve service related issues including appeals and complaints, eligibility determination and claims related issues for all product lines based on specified guidelines and timeframes while advising the customer of their rights and responsibilities. Additionally, the representative will assist with provider web inquiries, contract, pricing and fee schedule determinations. The Provider Service Representative will work closely with all departments such as Member Services, Claims Operations, Network Operations, Health Care Network Strategy, Provider Relations, Configuration and Membership and Billing to resolve provider inquiries as defined within Provider Services Procedures. The Provider Service Representative will also respond to inquiries received via written correspondence or by telephone call.
     
    QUALIFICATIONS:
    • High School diploma or GED with 2 years customer relations experience required, Associates Degree preferred.  
    • A background in health insurance claims and appeal processing is preferred.  
    • Additional experience in provider/practitioner billing and claim follow up preferred.  
    • Working knowledge of Microsoft Office applications is required.  Experience with a documentation system to track inquiries generated and received preferred.
    • Demonstrated ability to determine, analyze and solve problems related to benefits, claims appeals, claims pricing/processing by utilizing all applicable tools to make determinations is required. Demonstrated ability to successfully apply problem solving and time management methodology, balance multiple tasks as business needs arise while maintaining production and quality standards is required.
    • Ability to interpret contract language related to all CDPHP’s health plans to include riders and schedules to make eligibility determinations and verifications based on State statutes relating to healthcare administration and corporate guidelines.
    • Demonstrated ability to effectively communicate on a verbal and written basis with providers and other persons associated with CDPHP while maintaining a professional approach is required.
    • Demonstrated Ability to maintain a positive, professional demeanor. Ability to think creatively and participate in process improvement discussions as needed.

    Hourly salary rate: $20.00/hour

    CDPHP salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance. Some roles may also be eligible for overtime pay. 

    CDPHP compensation packages go far beyond just salary. The company offers a comprehensive total rewards package that includes award-winning health care coverage, health care dollars, a generous paid time off allowance, employee assistance programs, flexible work environment, and much more. Learn about all CDPHP employee benefits here.  

    As an Equal Opportunity / Affirmative Action Employer, CDPHP does not discriminate in employment practices on the basis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.

    CDPHP and its family of companies include subsidiaries Acuitas Health LLC, Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRX Services, LLC.
  • 1 Month Ago

E
Equal Opportunity Specialist 1 (Compliance)
  • Employee Relations, Office of
  • Albany, NY FULL_TIME
  • Non-Competitive: Six years of experience* in an equal opportunity, diversity and inclusion, minority business, employment compliance, human resources, labor relations or training position; OR a satisf...
  • 10 Days Ago

E
Contract Management Specialist 2
  • Employee Relations, Office of
  • Albany, NY FULL_TIME
  • Reachable on the Contract Management Specialist 2 eligible list OR eligible for a 52.6 transfer. Duties DescriptionUnder the direction of the Administrative Officer and Assistant Administrative Office...
  • 12 Days Ago

E
Administrative Assistant
  • Employee Relations, Office of
  • Albany, NY FULL_TIME
  • High School Diploma Two years of relevant experience.* Highly proficient in the use of Microsoft Office including Excel and PowerPoint. Excellent organizational, interpersonal, customer service and wr...
  • 16 Days Ago

E
Equal Opportunity Specialist 3 (Compliance)
  • Employee Relations, Office of
  • Rensselaer, NY FULL_TIME
  • Non-Competitive: Eight years of experience* in an equal opportunity, diversity and inclusion, minority business, employment compliance, human resources, labor relations or training position allocated ...
  • 16 Days Ago

E
Employee Program Assistant (Communications Assistant)
  • Employee Relations, Office of
  • Albany, NY FULL_TIME
  • Bachelor’s degree and two years of relevant experience. Experience providing graphic design for promotional materials, social media, and website content. Experience with writing and editing copy for b...
  • 27 Days Ago

Filters

Clear All

  • Filter Jobs by companies
  • More

0 Provider Relations Representative jobs found in Albany, NY area

I
Customer Relation Representative
  • Imperial Stars Acquisition LLC
  • Guilderland, NY
  • Job Description Job Description Do you have experience in customer service and management? Are you self-motivated and pu...
  • 3/28/2024 12:00:00 AM

H
Customer Service Representative - Remote
  • HealthHelp, Inc.
  • East Greenbush, NY
  • **Customer Service Representative - Remote** * 99 Troy Rd, East Greenbush, NY 12061, USA * Employees can work remotely *...
  • 3/28/2024 12:00:00 AM

B
Member Service Representative (Contact Center)
  • Broadview FCU
  • Albany, NY
  • If you are ready to join a company that truly cares about its employees, our members, and our community then you have co...
  • 3/28/2024 12:00:00 AM

B
Client Delivery Manager (Remote)
  • Broadridge Financial Solutions
  • Albany, NY
  • At Broadridge, we've built a culture where the highest goal is to empower others to accomplish more. If youre passionate...
  • 3/28/2024 12:00:00 AM

G
Guest Relations Representative
  • Great Escape
  • Queensbury, NY
  • What You Will Be Doing Assist Guests with the purchase of in park Admission and Group Sales Tickets as well as On-line T...
  • 3/27/2024 12:00:00 AM

N
Customer Relations Representative I
  • Norwaysavings
  • Windham, NY
  • **Building a better bank starts with hiring outstanding talent.** ***It starts with you.*** We truly have something spec...
  • 3/27/2024 12:00:00 AM

A
Patient Services Representative
  • Aspen Dental
  • Glenmont, NY
  • At Aspen Dental, we put You first, offering the security and job stability that comes with working with a world-class de...
  • 3/27/2024 12:00:00 AM

S
Loan Servicing Representative
  • Sunmark Credit Union
  • Latham, NY
  • Job Description Job Description People Helping People, that is what Sunmark Credit Union is all about! Why join the Sunm...
  • 3/27/2024 12:00:00 AM

Albany (/ˈɔːlbəni/ (listen) ALL-bə-nee) is the capital of the U.S. state of New York and the seat of Albany County. Albany is located on the west bank of the Hudson River approximately 10 miles (16 km) south of its confluence with the Mohawk River and approximately 135 miles (220 km) north of New York City. Albany is known for its rich history, commerce, culture, architecture, and institutions of higher education. Albany constitutes the economic and cultural core of the Capital District of New York State, which comprises the Albany–Schenectady–Troy, NY Metropolitan Statistical Area, including ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative jobs
$54,235 to $69,383
Albany, New York area prices
were up 1.5% from a year ago