Provider Relations Representative

The Provider Service Representative (PSR) plays a critical role in managing relationships with healthcare providers, ensuring smooth onboarding and contracting processes, and overseeing the accuracy of provider data within the system. This position is responsible for providing high-quality service to providers, resolving inquiries, facilitating contracting agreements, and maintaining up-to-date provider information in databases.

Key Responsibilities :

• Provider Services & Support :

Serve as the primary point of contact for healthcare providers responding to inquiries and resolving issues related to contract, rates and escalations.

• Assist with provider contracting, onboarding and education, ensuring they are properly enrolled in the system and have access to necessary tools and resources.
• Address and resolve provider complaints and issues, escalating to management when necessary.
• Contracting :

Coordinate the contracting process for new and existing providers, including drafting and reviewing contracts, ensuring compliance with all regulatory and network requirements.

• Collaborate with the contracting team to negotiate and finalize provider agreements, ensuring terms are fair and align with company policies.
• Track contract statuses and ensure timely renewals, amendments, and terminations in accordance with organizational needs and timelines.
• Provider Data Management :

Ensure the accuracy and integrity of provider data within the system, including demographic details, specialties, affiliations, and contract terms.

• Regularly update and audit provider data to ensure compliance with company and regulatory standards.
• Coordinate with the data management team to ensure discrepancies are identified and corrected in a timely manner.
• Assist in maintaining accurate provider directories for internal and external use.
• Cross-Functional Collaboration :

Collaborate with internal teams such as Claims, Credentialing, Compliance, and Network Management to ensure smooth operations related to provider services, contracting, and data management.

• Assist in the development and implementation of process improvements to enhance provider experience and efficiency in contracting and data management.
• Reporting and Analysis :

Generate reports related to provider inquiries, contract statuses, and data accuracy as needed.

• Analyze provider data trends and provide insights to leadership for decision-making.
Qualifications :

The Provider Service Representative (PSR) plays a critical role in managing relationships with healthcare providers, ensuring smooth onboarding and contracting processes, and overseeing the accuracy of provider data within the system. This position is responsible for providing high-quality service to providers, resolving inquiries, facilitating contracting agreements, and maintaining up-to-date provider information in databases.

Key Responsibilities :

• Provider Services & Support :

Serve as the primary point of contact for healthcare providers responding to inquiries and resolving issues related to contract, rates and escalations.

Coordinate the contracting process for new and existing providers, including drafting and reviewing contracts, ensuring compliance with all regulatory and network requirements.

Ensure the accuracy and integrity of provider data within the system, including demographic details, specialties, affiliations, and contract terms.

Collaborate with internal teams such as Claims, Credentialing, Compliance, and Network Management to ensure smooth operations related to provider services, contracting, and data management.

Generate reports related to provider inquiries, contract statuses, and data accuracy as needed.

Bachelor or higher degree is required;

3+ years of experience in provider services, healthcare operations, or related field required.

Strong communication and interpersonal skills to effectively engage with providers.

Ability to work independently and as part of a team in a fast-paced environment.

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