Provider Relations Representative

Careabout; New York (NY); On-site; USD 60,000 - 74,000; Full time

Job summary

A leading healthcare company seeks a Provider Relations Representative to develop and maintain strong relationships with healthcare providers. This role will involve educating providers on various operational topics while managing performance metrics in a value-based care framework. The successful candidate will thrive in a fast-paced environment and possess excellent communication and analytical skills.

Qualifications

• 2-3 years of medical utilization experience.
• Knowledge of provider reimbursement and coding.
• Experience in customer service/relations-like roles.

Responsibilities

• Develop & maintain relationships with providers.
• Educate staff on health plan operations and quality metrics.
• Monitor and report on key programs performance metrics.

Skills

Communication

Analytical Skills

Attention to Detail

Education

High School Graduate/Equivalent

BA / Associate Degree

Tools

Microsoft Office

ZOOM

Teams

WebEx

Job description

3 days ago Be among the first 25 applicants

The Provider Relations Representative develops & maintains positive relationships with physicians, providers, and practice managers within our participating provider network, including oversight & managing performance in various incentives based and/or value-based programs. Responsible for educational needs of providers and their office staff in any matters concerning provider relationships with MSPB and network service issues. Facilitates the development of a comprehensive provider network and serves as the primary contact, offering education, technical assistance and problem solving as necessary. Key Responsibilities / Essential Functions: Develop & maintain positive relationships with providers, ensure provider adherence to contractual requirements, and educate providers and office staff on topics including, but not limited to health plan operations/policies and procedures, preventative & quality outcome metrics & risk adjustment. Responsible for understanding, developing, tracking, monitoring, and reporting on key programs performance metrics, such as STARs, HEDIS, and other quality performance measures. Prepares for and participates in meetings with providers and provider staff and plans, creates & delivers agendas and/or presentations. Work closely with providers & office staff to encourage membership growth & member retention. Provide follow-up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled. Provide educational updates monthly or as necessary with providers and office staff on changes within VBC. Performs other duties as assigned. Skills and Competencies: Proven record of leading a team with successful outcomes. Proficient in Microsoft Office skills (Excel, Word, Access, etc.) Able to organize and lead ZOOM, Teams, WebEx, and other virtual meeting environments. Ability to effectively communicate in English, both verbally and in writing Enjoys working in both individual and team settings. Able to execute projects in a fluid and fast paced environment. Good communication and relationship skills Strong analytical skills Attention to detail. High level of energy Qualifications: High School Graduate/Equivalent; BA / associate degree preferred. 2-3 years of medical utilization experience, including but not limited to reviewing claims, Value Based Care, MRA/HCC understanding, front end operations experience. Knowledge of provider reimbursement, Medicare reimbursement, coding and HEDIS Measures and care gap reporting preferred. Understanding of provider office dynamics and optimal approaches to communicating and educating providers and provider staff Understanding of provider reimbursements and coinciding challenges (FFS, CPT code reimbursement, etc.) MRA & VBC knowledge. Experience in customer service/relations-like roles Healthcare experience. Physical Requirements: Can travel 30%-50% per month, comfortably transition between different work positions as needed. Capable of handling objects up to 35 pounds when necessary. Will occasionally need to move medical equipment using pushing or pulling motions. May involve tasks such as bending, stooping, kneeling, or reaching as required. Proficient use of computer keyboards is essential, and phone-related tasks are part of the job requirement.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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