Provider Relations Representative jobs in Arizona

Provider Relations Representative supports, develops and maintains service relationships with all participants (physicians, providers and administrators) of a provider network. Responds to electronic and direct inquiries from clients about policies, rates, changes, referrals, eligibility, credentialing, etc. Typically requires a bachelor's degree. Being a Provider Relations Representative typically reports to a supervisor or manager. The Provider Relations Representative works on projects/matters of limited complexity in a support role. Work is closely managed. To be a Provider Relations Representative typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)

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Provider Relations Manager
  • State of Arizona
  • PHOENIX, AZ FULL_TIME
  • AHCCCS

    Arizona Health Care Cost Containment System
    Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork

    The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.

    AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.

    Come join our dynamic and dedicated team.

    Provider Relations Manager

    Division of Fee for Service Management

    Job Location:

    Address: 801 E. Jefferson Street, Phoenix, AZ 85034

    Posting Details:

    Salary: $83,600 

    Grade: 23

    Closing Date: Open Until Filled

    Job Summary:

    Under the direction of the Claims Operational Administrator, this position is responsible for overseeing the provider network team and ensuring timely and accurate responses to provider services tickets related to the Division of Fee-for-Service Management (DFSM) claims and/or prior authorization. The Provider Network Manager is the main point of contact for in-depth meetings related to DFSM claims and/or prior authorization concerns, inquiries, and/or escalations.

    This position has the potential to work from a Virtual Office (VO) setting or may Telecommute based on the needs of the unit and at the discretion of leadership.

    Major duties and responsibilities include but are not limited to:
    • Leads and oversees the Provider Network team who respond to Services Tickets submitted by provider organizations to the Division of Fee-for-Service Management (DFSM). Provides training and support to staff in responding to claims and prior authorization service tickets.
    • Leads and attends meetings as requested with provider organizations to answer questions and identify issues. Works with providers to resolve claims and/or prior authorization issues.
    • Tracks data related to service tickets and reports back to leadership. Ensures timely and accurate responses to provider services tickets.
    • Facilitates the Joint Operations Committee (JOC) Meetings with provider organizations. Takes notes and records discussion items in the JOCs.
    • Works collaboratively with Division of Business & Finance (DBF), Information Systems Division (ISD), provider enrollment, and member services to ensure provider needs are met and solve complex problems.
    • Works closely wit the Adjudication unit to identify and resolve claims system problems. Makes DFSM leadership aware of findings.
    • Makes referrals to the Office of Inspector General (OIG) for suspected Fraud, Waste, and Abuse.
    • Responds to escalated inquiries from the executive leadership team.

    Knowledge, Skills & Abilities (KSAs):

    Knowledge:
    • Principles and practices of supervision and staff development
    • Principles and practices of provider network relations
    • AHCCCS, ALTCS, Medicaid and Medicare Regulations
    • State Statute and Rule and Policies applicable to AHCCCS Programs, AHCCCS Policies and Procedures
    • Fundamentals of IHS/638 claims processing and billing
    • Familiarity AHCCCS' Information Management System, Prepaid Medical Management Information System (PMMIS)

    Skills:
    • Excellent problem solving skills
    • Proficient in Microsoft and Google Suite, etc.
    • Excellent customer service skills
    • Project management of multiple assignments
    • Analyze and effectively recommend resolution to provider issues

    Abilities:
    • Communicate effectively and clearly verbally and in writing
    • Read and understand medical records
    • Understand medical terminology
    • Work independently with minimal direction
    • Interpret rules and regulations, policies, and procedures as it related to the program
    • Work Virtual Office or Telecommute or both

    Qualifications:

    Arizona State Drivers License

    Minimum:
    • Four years professional experience related to health programs appropriate to the assignment, which includes experience in Healthcare Administration AND Two plus years of managerial experience. Experience with medical claims and coding, Arizona Medicaid, and medical records.

    Preferred:
    • Bachelors or Masters Degree in Healthcare Administration or in related field. Experience in both behavioral health administration and medical services administration. Certified coder. Familiarity with PMMIS, Cognos, and/or AHCCCS policies.

    Pre-Employment Requirements:

    • Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
    • Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
    • Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.

    If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements.

    All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

    Benefits:

    Among the many benefits of a career with the State of Arizona, there are:
    • 10 paid holidays per year
    • Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
    • Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
    • Other Leaves - Bereavement, civic duty, and military.
    • A top-ranked retirement program with lifetime pension benefits
    • A robust and affordable insurance plan, including medical, dental, life, and disability insurance
    • Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
    • RideShare and Public Transit Subsidy
    • A variety of learning and career development opportunities

    By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

    Learn more about the Paid Parental Leave pilot program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

    Retirement:

    Lifetime Pension Benefit Program
    • Administered through the Arizona State Retirement System (ASRS)
    • Defined benefit plan that provides for life-long income upon retirement.
    • Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
    • Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

    Deferred Retirement Compensation Program
    • Voluntary participation.
    • Program administered through Nationwide.
    • Tax-deferred retirement investments through payroll deductions.

    Contact Us:

    Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.
    Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.

  • 11 Days Ago

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Specialist - Credentialing, Licensing & Provider Relations
  • StaffDocs
  • , AZ FULL_TIME
  • This is a remote position. If you are a team player and are ready to grow your career, please take a few minutes to find out if this is the right opportunity for you. Do you have prior experience in l...
  • 8 Days Ago

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Customer Relations Representative
  • TEKsystems
  • Phoenix, AZ CONTRACTOR
  • Description: Provides customer service by responding to a wide variety of customer and member hotel inquiries and requests. Resolves guest and member issues to satisfaction. Will handle some calls inv...
  • 4 Days Ago

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Customer Relations Representative
  • iMemories
  • Scottsdale, AZ FULL_TIME
  • Job Description Job Description Who We Are iMemories is the largest and most trusted digitization company, reinventing how family memories are experienced in today’s cloud-connected, multi-screen worl...
  • 4 Days Ago

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PR Account Executive
  • Trust Relations
  • Williams, AZ FULL_TIME
  • Company Description Trust Relations Overview Trust Relations is a fast-growing, virtual branding, and strategic communications agency. We bypass the traditional agency model to build trusted brands, c...
  • 21 Days Ago

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PR Account Executive
  • Trust Relations
  • Coconino County, AZ OTHER
  • Company Description Trust Relations Overview Trust Relations is a fast-growing, virtual branding, and strategic communications agency. We bypass the traditional agency model to build trusted brands, c...
  • 4 Days Ago

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Guest Relations Representative
  • Six Flags Great Adventure
  • Jackson, NJ
  • Assist Guests with questions, comments, concerns they may have about their experience while visiting Six Flags. Resolve ...
  • 3/29/2024 12:00:00 AM

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Senior Provider Relations Representative
  • University Health System
  • San Antonio, TX
  • Full Time 12238 Silicon Drive Professional Non-Nursing Day Shift POSITION SUMMARY/RESPONSIBILITIES Working with Departme...
  • 3/27/2024 12:00:00 AM

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Guest Relations Representative
  • Great Escape
  • Queensbury, NY
  • What You Will Be Doing Assist Guests with the purchase of in park Admission and Group Sales Tickets as well as On-line T...
  • 3/27/2024 12:00:00 AM

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Donor Relations Representative
  • Christus Health
  • Irving, TX
  • Description Summary: Responsible for gift processing and donor relations including: responding to all donor inquiries, r...
  • 3/27/2024 12:00:00 AM

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Customer Relations Representative
  • Catalyst Career Group
  • Dallas, TX
  • Job Description Job Description Collaborative. Respectful. A place to dream and do. These are just a few words that desc...
  • 3/27/2024 12:00:00 AM

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Provider Relations Representative
  • Molina Healthcare
  • Long Beach, CA
  • Job Description ***Remote and must live in the Riverside or San Bernardino areas*** Job Description Job Summary Molina H...
  • 3/25/2024 12:00:00 AM

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Provider Relations Representative
  • MBI Health Services
  • Los Angeles, CA
  • Job Description Job Description Position Title: Provider Relations Representative Job Type: Full-Time / Hybrid Departmen...
  • 3/25/2024 12:00:00 AM

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Provider Relations Representative (Buffalo/WNY Territory)
  • Univera Healthcare
  • Buffalo, SC
  • Job Description: This position serves as the primary contact between Providers and the organization. The position is res...
  • 3/24/2024 12:00:00 AM

Arizona (/ˌærɪˈzoʊnə/ (listen); Navajo: Hoozdo Hahoodzo Navajo pronunciation: [xòːztò xɑ̀xòːtsò]; O'odham: Alĭ ṣonak Uto-Aztecan pronunciation: [ˡaɺi ˡʂonak]) is a state in the southwestern region of the United States. It is also part of the Western and the Mountain states. It is the sixth largest and the 14th most populous of the 50 states. Its capital and largest city is Phoenix. Arizona shares the Four Corners region with Utah, Colorado, and New Mexico; its other neighboring states are Nevada and California to the west and the Mexican states of Sonora and Baja California to the south and so...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative jobs
$52,343 to $66,963