Provider Relations Rep
The Provider Relations Representative is critical to the overall success of the company. New and established Health care providers value great service and maintenance throughout the term of the agreement. Service includes consistent telephonic, face-to-face and written communication and interaction in order to establish and retain positive and successful relationships with the provider network. The Provider Relations Representative shall be relationship oriented, requiring someone with an outgoing personality, attention to detail, and firm understanding of the health care delivery system. Maintains a professional, positive and caring attitude at all times.
Some of the duties include:
- Assists with investigating and resolving administrative issues and concerns between AZPC, provider networks and the health plans.
- Maintains regular schedule of physician office visits to ensure open lines of communication between AZPC and the provider network.
- Coordinates the in-office support for AZPC Network Services and Administration including, but not limited to: Written and oral communication with providers, Monthly preparation and distribution of capitation packets, as applicable; Receive and respond to incoming phone calls and emails; Verification of provider effective dates, termination dates, open/closed panel status, demographic information and health plan identification numbers; Monitor and track provider HMO membership movement; Retroactive member months requests from health plans, as applicable.
- Develops and maintains provider relationships and serves as the primary resource for internal staff and provider pertaining to provider network.
- Assists with marketing AZPC by attending and participating in employer group events.
- Significant travel in your personal vehicle to local provider offices and events.
- Special projects and other duties as assigned by management.
- Valid driver’s license and proof of insurance and good driving record
- Proficient in office equipment (computers, printers, etc.) and MS Office programs (Word, Excel, PowerPoint, and Access); EZ-Cap experience a plus.
- Excellent written and verbal communication skills.
- Ability to maintain confidentiality
- Ability to multi-task and prioritize effectively and efficiently in a high-stress environment.
- Knowledge of HMO, PPO, Medicare Risk and Indemnity products preferred; Accuracy and detail orientation (written and verbal)
- Must be able to interact with providers in a professional manner with a strong commitment to positively representing the company
Prior experience with Network Contracting with physicians
Associates degree or relevant equivalent experience