Provider Relations Representative

Prime Healthcare; Ontario (CA); On-site; USD 34,000 - 38,000; Full time

Benefits offered by this job

401K retirement plan

Medical, dental, and vision coverage

Paid time off

Job summary

Prime Healthcare in Ontario, CA is hiring a Provider Relations Representative to act as the main contact for providers and to bridge Prime Healthcare Employee Health Plan with medical providers.

You will maintain contract and practice information, respond to claim inquiries, benefit questions, and member issues, while documenting interactions with precision and timeliness. Strong communication and problem-solving are essential.

Qualifications

• Must have high school graduate or healthcare administration/business degree.
• 1 year of provider services or provider contracting experience in healthcare.
• Knowledge of CPT/ ICD-10 codes and billing terms.
• Strong communication, problem-solving and customer service.
• Computer literacy in Microsoft Office Windows.

Responsibilities

• Serve as primary contact for providers and liaison between health plan and providers.
• Maintain current contract and practice information and address inquiries.
• Document interactions accurately and timely to support efficient service.

Skills

Communication skills

Customer service

Problem-solving

Microsoft Office

Education

High School Diploma or equivalent

Associate's degree preferred

Tools

Microsoft Office

Job description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Responsibilities

The Provider Relations Representative serves as a primary point of contact for providers, acting as a liaison between the Prime Healthcare Employee Health Plan and medical providers. The representative is responsible for maintaining and strengthening provider relationships by communicating health plan updates, ensuring contract information/practice information remains current, and addressing claim inquiries, benefit questions, and member issues.

This position requires proficiency in utilizing multiple communication channels, strong attention to detail, problem-solving skills, and meticulous documentation to ensure accurate, timely, and efficient assistance is provided.

Qualifications

Required qualifications:

• High School Graduate or a degree in healthcare administration or business
• 1 year of provider services or provider contracting experience in the healthcare industry.
• Knowledge of or experience with CPT, ICD-10 codes, billing and insurance terminology.
• Strong communication, problem-solving, and customer service
• Computer literate in Microsoft Office Windows

Preferred qualifications:

• Associate's degree from an accredited institution.

Pay Transparency

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $24.33 to $27.74. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf