Provider Relations Specialist

Network Solutions IPA; New York (NY); On-site; USD 55,000 - 75,000; Full time

Job summary

Network Solutions IPA is seeking a Provider Relations Representative to be the primary liaison with community network providers. This role focuses on developing relationships to enhance provider satisfaction, manage issues related to credentialing, and conduct training. Ideal candidates will have healthcare experience and strong interpersonal skills, contributing to membership growth and network expansion.

Qualifications

• At least 2 years experience in a health care environment.
• Direct Provider Relations experience is highly desirable.
• Strong customer service skills and communication skills are essential.

Responsibilities

• Develop and maintain relationships with network providers.
• Conduct educational training seminars for provider networks.
• Assist in marketing initiatives to reach membership goals.

Skills

Customer Service

Organizational

Analytical

Verbal Communication

Written Communication

Presentation

Job description

Provider Relations Representative is the primary liaison between Network Solutions IPA and its community network providers; responsible for developing and maintaining positive relationships with designated providers to increase participation and satisfaction, including resolution of credentialing and contracting issues, providing on-going training's, acting as a dedicated resource to our providers.Essential Functions/Responsibilities:

• Distribution and collection of provider contracts and related documents; preparation of complete contract/application packets to be submitted to the NSIPA credentialing process
• Plans, organizes and conducts educational training seminars for the assigned provider network
• Works with internal staff to resolve provider issues with regard to billing, payments, denials, authorizations, and other interactions; assist in the development and implementation of organizational solutions to prevent future problems
• Assist in marketing initiatives to reach membership goals
• Assist in ongoing identification of providers needed for network completion or expansion (physicians, ancillary providers, community agencies, advocacy groups, etc.)
• Distribute provider manuals and other materials as necessary
• Manage and/or support other projects and activities as assigned

Accountability:Identify and develop a portfolio of providers to support ongoing Membership growth and network expansion in assigned regions and/or with assigned providersSupport all provider relations initiatives and contribute to efficient and effective provider supportKnowledge:Working knowledge of healthcare credentialing & reimbursement methodologiesExperience:At least 2 years’ experience working in a health care environment, preferably in the managed care industryAt least 2 years’ experience working with managed care systems (claims processing, enrollment, etc.)Direct Provider Relations experience highly desirableSkills/Aptitudes:Strong Customer Service skillsStrong organizational, analytical, and follow-up skillsStrong verbal and written communication skillsStrong Presentation SkillsAbility to work well with physicians, clinicians, practice and health system administrators, as well as frontline provider staffAbility to work independently, flexibly, reliably, and assertively in fast-paced environmentNetwork of existing relationships with providers highly desirable

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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