Job Title: Provider Relations Representative
Primary job responsibilities involve assisting the Provider
Relations Managers with the providers and the provider network.
Respond to provider related inquiries received by letter, phone, or
internal departments. Assures providers receive exceptional service
and response level. Reviews and monitors provider complaints,
grievances and escalate issues as necessary to the appropriate
Provider Relations Manager. Prepares provider blast fax for
newsletters/bulletins. Assist with departmental administrative
tasks, as needed. Must be flexible and disciplined enough to
multi-task while handling a variety of duties. Attend local Open
Enrollment Meetings as appropriate to support clients and
DUTIES AND ACCOUNTABILITIES:
? Initial contact and responder to provider related inquiries
received by letter, phone, or internal departments.
? Work closely with Provider Relations Managers to assure providers
receive exceptional service and response and escalate issues as
? Provide continual evaluation of processes and procedures in the
department and suggest methods to improve efficiency and service
? Resolve member incident reports and provider complaints and
demonstrate the ability to be resourceful in problem solving.
? Update changes in provider?s practice information such as TIN?s
? Assist in recruitment projects, network comparisons and data
? Process all outgoing application packets and follow-up letters on
a weekly basis.
? Distribution of Provider Bulletins & Newsletters
?Resolve claims issues related to insufficient provider information
and make necessary corrections and update databases.
? Administer accurate data entry into multiple provider systems
including Access and claims processing systems.
? Assure providers have the appropriate training and resources by
participating in provider office education.
? Attend local Open Enrollment Meetings as required to support
clients and providers.
? Establish work procedures and processes for Provider Relations
that support company and departmental standards and strategic
? Perform other related duties as assigned.
Education: High school graduate. Two to three years of college or
Experience: Requires 7+ years administrative experience. Preferably
previous health care experience in a managed health care
environment, provider relations or customer service,
including working with members and providers. Excellent computer
skills and proficiency with word processing and spreadsheets. Also
requires excellent verbal and written communication skills to
communicate with providers via phone and written correspondence.
Experience and ability to prioritize multiple tasks appropriately.
Understanding of vision care insurance is a plus.
We are an equal employment opportunity employer and will consider
all qualified candidates without regard to disability or protected