The Provider Relations Representative takes responsibility for building and cultivating a relationship with users and ensures a high level of customer service. A well-drafted Provider Relations Representative Resume lists the following tasks and duties – providing professional customer service, identifying ways to enhance processes, providing support for other projects in the company, responding to inquiries from providers, using specific software, negotiating contracts, reviewing and revising contracts, maintaining provider databases, handling complaints from providers, developing letters of agreement, maintaining provider documentation files and performing financial analysis pertaining to provider contracts.
The most sought-after skills and qualifications include the following – technical skills, relationship management, conflict resolution skills, interpersonal abilities, strong communication skills, the ability to remain polite while dealing with angry providers; and negotiation skills. The ideal candidate for this post should depict on their resume a bachelor’s degree in business or other related fields.
Objective : Dedicated healthcare professional with two years of experience in provider relations and support. Proven ability to foster strong relationships with healthcare providers while effectively addressing inquiries and concerns. Skilled in educating providers on policies, managing complaints, and coordinating training to enhance service delivery.
Skills : Healthcare Data Analysis, Claims Resolution And Appeals, Communication Skills, Problem Solving
Description :
Served as the primary point of contact for providers, addressing inquiries and providing timely support.
Conducted training sessions for new providers, ensuring understanding of policies and procedures.
Collaborated with internal teams to resolve provider issues and enhance service delivery.
Maintained accurate records of provider interactions and training sessions.
Developed educational materials to improve provider knowledge of services and compliance.
Monitored provider feedback to identify areas for improvement in service delivery.
Participated in contract compliance reviews to ensure adherence to agreements.
Experience
0-2 Years
Level
Entry Level
Education
B.S. HCA
Senior Provider Relations Representative Resume
Headline : Dynamic healthcare specialist with 7 years in provider relations, adept at building strong partnerships with healthcare providers. Demonstrated expertise in resolving claims issues, conducting training sessions, and enhancing operational efficiency. Committed to improving provider experience and ensuring compliance with regulations, contributing to superior care delivery.
Managed relationships with over 200 physician accounts across Medicaid and commercial insurance sectors.
Conducted comprehensive training for physicians and medical staff on claims processing and authorization procedures.
Oversaw account management for private practices across 17 cities, ensuring optimal service delivery.
Performed site visits to evaluate provider facilities and compliance with healthcare standards.
Recruited and onboarded Medicaid and Medicare providers into the network.
Resolved provider grievances and conducted thorough investigations into claims denials.
Facilitated training sessions for diverse medical personnel on member plans and claims processing workflows.
Experience
5-7 Years
Level
Senior
Education
B.S. HCA
Provider Relations Representative Resume
Objective : Results-oriented professional with two years of experience in provider relations, specializing in building effective partnerships with healthcare providers. Proficient in addressing provider inquiries, conducting training sessions, and implementing strategies to enhance network performance. Committed to optimizing provider satisfaction and ensuring compliance with industry standards.
Skills : Crm Software Skills, Microsoft Office Suite, Telecommunication Skills, Cultural Competence, Project Management, Analytical Thinking
Description :
Acted as a liaison between Universal Health Network (UHN) and healthcare providers for recruiting, contracting, and supporting UHN networks.
Analyzed provider contracts and modified fee schedules to ensure competitive rates.
Negotiated rates with providers based on comprehensive network analysis.
Served as the primary contact for healthcare providers, addressing concerns and facilitating necessary training.
Identified network gaps and recruited qualified providers to meet client needs.
Executed recruitment initiatives, including targeted mailings and tracking outcomes.
Possessed in-depth knowledge of various fee schedule methodologies, enhancing negotiation strategies.
Experience
0-2 Years
Level
Junior
Education
B.S. Health Admin.
Provider Relations Representative I Resume
Summary : Accomplished provider relations expert with 10 years of experience enhancing partnerships within the healthcare sector. Proficient in resolving provider issues, delivering training sessions, and ensuring compliance with policies. Committed to improving provider satisfaction and streamlining communication to foster collaborative relationships.
Skills : Healthcare Quality Metrics, Healthcare Knowledge, Active Listening, Empathy, Data Analysis, Time Management
Description :
Acted as the primary liaison to the Primary Care Association, addressing and resolving issues with community health centers.
Oversaw the accuracy and updates of provider-related database information requests through PDM.
Educated providers on policies, claims submission processes, and EDI problem-solving.
Reviewed and updated provider manuals and policies to reflect new health plan protocols.
Authored change requests and managed testing processes to ensure successful implementation.
Conducted daily outreach to community health centers, providing solutions to provider inquiries.
Proven ability to thrive in a collaborative team environment while maintaining high energy and motivation.
Experience
7-10 Years
Level
Management
Education
B.S. Health Admin.
Provider Relations Representative Resume
Headline : Healthcare professional with 7 years of experience in provider relations, excelling in relationship management and issue resolution. Proven track record of enhancing provider satisfaction through effective communication and training initiatives. Passionate about optimizing healthcare delivery and ensuring compliance with industry standards while fostering a collaborative environment.
Serviced all contracted providers within Miami-Dade County, ensuring compliance with service agreements.
Conducted new provider orientations and in-services for all applicable product lines within established timelines.
Performed site evaluations to resolve issues and educate staff on policies and procedures.
Achieved call reach and frequency goals to maintain strong relationships with provider offices.
Oversaw inquiries and claims issues, following up to ensure resolution and provider satisfaction.
Supported regional Network Improvement Plan targets by analyzing utilization reports and other key metrics.
Ensured accuracy and completeness of documentation for new and existing providers, including credentialing updates.
Experience
5-7 Years
Level
Senior
Education
B.S. in HA
External Provider Relations Representative Resume
Objective : Accomplished professional with 5 years of experience in external provider relations, specializing in building productive partnerships with healthcare providers. Adept at addressing provider inquiries, facilitating compliance training, and enhancing operational efficiency to improve healthcare delivery. Committed to fostering positive relationships that drive superior service outcomes.
Educate providers on policy updates, claims procedures, and reimbursement processes through engaging workshops and in-person meetings.
Conduct routine audits of medical records to ensure compliance with state standards in medical practices.
Manage recruitment and retention efforts for healthcare providers participating in the Texas Medicaid program.
Ensure compliance with contractual obligations by performing regular audits of provider practices.
Identify and address deficiencies in provider operations through targeted educational initiatives.
Research and analyze medical policies, rates, and procedures to support the Texas Medicaid program.
Collaborate with internal teams to enhance service delivery and provider satisfaction.
Experience
2-5 Years
Level
Management
Education
B.S. Health Admin.
Provider Relations Representative Resume
Objective : Healthcare professional with two years of experience in provider relations, adept at developing partnerships with healthcare providers. Experienced in resolving inquiries, educating on policies, and implementing training initiatives to optimize service quality. Passionate about enhancing provider satisfaction and ensuring compliance within healthcare operations.
Skills : Conflict Resolution, Regulatory Compliance, Attention To Detail, Quality Assurance, Team Collaboration, Interpersonal Skills
Description :
Maintain strong working relationships with physicians, facilities, and physician groups.
Assist in the recruitment and credentialing of new providers.
Educate providers on new protocols and resolve issues related to policies and services.
Ensure accurate maintenance of provider databases and documentation.
Conduct training sessions to enhance provider knowledge of policies and procedures.
Negotiate agreements with providers, ensuring compliance with organizational standards.
Research and resolve claims and administrative issues affecting network providers.
Objective : Healthcare advocate with two years of hands-on experience in provider relations, adept at cultivating partnerships and resolving complex inquiries. Demonstrated proficiency in educating providers about policies and enhancing service quality through effective communication. Passionate about optimizing provider engagement and ensuring compliance to support exceptional healthcare delivery.
Skills : Healthcare Communication, Client Retention, Market Research, Strategic Planning, Customer Feedback Analysis, Training And Development
Description :
Maintained and strengthened provider relationships by leveraging comprehensive knowledge of health plans to resolve inquiries and issues.
Collaborated with the Sales Team to identify and recruit diverse healthcare providers to enhance network access.
Utilized extensive policy knowledge to effectively address questions related to contracting, claims payments, and plan structures.
Facilitated cross-departmental collaboration to implement provider education initiatives and communication tools.
Managed provider accounts to ensure accurate and up-to-date billing and practice location data.
Supported Sales initiatives by serving as a key Contract Negotiator.
Expanded the client base through strategic outreach and recruitment of healthcare providers.
Experience
0-2 Years
Level
Entry Level
Education
B.S. Health Admin.
Provider Relations Representative Resume
Objective : Experienced Provider Relations Representative with 5 years in healthcare, skilled in developing and maintaining provider partnerships. Expertise in resolving complex inquiries, educating providers on policies, and enhancing operational efficiency. Dedicated to improving provider satisfaction and ensuring compliance with industry standards to support exceptional healthcare delivery.
Skills : Provider Engagement, Data Management, Negotiation Skills, Reporting And Analysis, Documentation Management, Client Relations
Description :
Educated and supported providers regarding BCBS policies, enhancing understanding and compliance.
Delivered high-quality customer service, addressing inquiries about the application process and resolving issues promptly.
Accurately recorded and managed data for processing shipped records, ensuring efficiency.
Coordinated communication among departments within the BCBS System to deliver exceptional customer support.
Engaged with providers and claimants to correct claim form errors and investigate discrepancies.
Provided clear guidance through effective communication channels, enhancing service delivery.
Applied medical terminology and coding knowledge to process claims accurately, improving workflow.
Experience
2-5 Years
Level
Consultant
Education
B.S. Health Admin.
Senior Provider Relations Representative Resume
Headline : Accomplished provider relations professional with 7 years of experience in building and nurturing partnerships within the healthcare sector. Expertise in contract negotiation, training facilitation, and compliance management. Focused on enhancing provider satisfaction and streamlining communication to drive operational improvements and superior service delivery.
Negotiated and finalized contracts with high-volume hospitals, enhancing service delivery.
Managed an Access database of contracts and applications for prospective providers and key facilities.
Facilitated weekly status meetings with the contracting department to ensure timely integration.
Processed out-of-network agreements identified by the Health Services Management Department.
Conducted comprehensive fee schedule analyses for physicians and facilities, optimizing reimbursement rates.
Reviewed workflow processes and set customer expectations regarding contract implementation.
Proactively contacted new providers to ensure timely submission of credentialing applications.
Experience
5-7 Years
Level
Management
Education
B.S. Health Admin.
Provider Relations Representative Resume
Objective : Healthcare expert with 5 years of dedicated experience in provider relations, proficient in strengthening partnerships and enhancing communication with healthcare providers. Skilled in resolving complex issues, educating on policy compliance, and delivering training to optimize service delivery. Committed to fostering positive relationships that elevate provider satisfaction and improve healthcare outcomes.
Facilitated communication between healthcare providers and insurance companies.
Collaborate directly with providers to enhance healthcare delivery, swiftly resolving issues and ensuring ongoing support.
Act as a key resource for the executive medical team in credentialing processes, ensuring adherence to regulatory standards.
Serve as a subject matter expert on credentialing policies and regulations, providing insights for compliance.
Conduct comprehensive financial analysis related to physician compensation, influencing strategic decision-making.
Oversee fiscal management, tracking, and monitoring of program budgets to optimize operational efficiency.
Revamped credentialing evaluation reporting mechanisms, enhancing the decision-making process for the board of physicians.
Experience
2-5 Years
Level
Management
Education
B.S. Health Admin.
Provider Relations Representative Resume
Objective : Accomplished provider relations advocate with two years of experience in strengthening partnerships with healthcare providers. Demonstrated ability to resolve inquiries swiftly, educate on policies, and facilitate training initiatives to enhance service quality. Passionate about optimizing provider experiences and ensuring compliance to support superior healthcare delivery.
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