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 contracts, rates, and escalations.

Assist with provider contracting, onboarding, and education, ensuring proper enrollment in the system and 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 to ensure 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 identify and correct discrepancies promptly.

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 developing and implementing process improvements to enhance provider experience and operational efficiency.

• Reporting and Analysis :

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

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

• Qualifications :

Education : Bachelor’s degree or higher is required.

Experience : At least 3 years of experience in provider services, healthcare operations, or a related field. Experience in healthcare contracting and provider data management is strongly preferred.

Knowledge of healthcare systems, networks, and regulations is essential.

Familiarity with provider data systems and databases is required.

Language Skills : Fluency in English and French is mandatory; additional languages are a plus.

Skills :

• Strong communication and interpersonal skills for effective engagement with providers.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook).
• Attention to detail with strong organizational skills and ability to manage multiple tasks.
• Ability to interpret and apply healthcare policies and guidelines.
• Strong problem-solving and critical thinking skills.
• Ability to work independently and collaboratively in a fast-paced environment.

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