Provider Relations Representative jobs in South Carolina

Job Summary: The Provider Relations Coordinator serves as a liaison between the healthcare organization and its network of healthcare providers, including physicians, specialists, hospitals, clinics, and other healthcare facilities. They are responsible for maintaining strong relationships, addressing concerns, and ensuring effective communication between the organization and its provider network.

Responsibilities:

1. Provider Network Management:

   • Develop and maintain positive relationships with healthcare providers within the organization's network.
   • Serve as the primary point of contact for provider inquiries, concerns, and issues.
   • Collaborate with internal departments to address provider needs and facilitate resolutions.

2. Contract Management:

   • Assist in the negotiation, implementation, and maintenance of contracts with healthcare providers.
   • Ensure compliance with contract terms and conditions.
   • Communicate contract updates and changes to providers as needed.

3. Provider Education and Training:

   • Coordinate provider orientation sessions and ongoing training programs.
   • Educate providers on organizational policies, procedures, and initiatives.
   • Facilitate communication of clinical guidelines, quality measures, and regulatory requirements to providers.

4. Issue Resolution:

   • Address provider concerns and inquiries in a timely and professional manner.
   • Investigate and resolve issues related to claims processing, reimbursement, credentialing, and other operational matters.
   • Escalate complex issues to appropriate departments or management for resolution.

5. Provider Communication:

   • Communicate updates, changes, and important information to providers via newsletters, bulletins, and meetings.
   • Gather feedback from providers and communicate their needs and preferences to relevant stakeholders within the organization.

6. Quality Improvement:

   • Collaborate with quality improvement teams to implement initiatives aimed at enhancing provider satisfaction and improving patient outcomes.
   • Analyze provider performance data and identify opportunities for improvement.

7. Network Development:

   • Assist in the recruitment and onboarding of new providers to expand the organization's network.
   • Conduct provider outreach activities to promote collaboration and engagement.

8. Compliance and Regulatory Compliance:

   • Ensure adherence to regulatory requirements, accreditation standards, and contractual obligations.
   • Maintain documentation and records related to provider interactions and agreements.

Qualifications:

• Bachelor's degree in healthcare administration, business administration, or related field (preferred).
• Previous experience in provider relations, network management, or healthcare administration.
• Knowledge of healthcare delivery systems, reimbursement mechanisms, and managed care practices.
• Familiarity with healthcare regulations, including HIPAA, Medicare, and Medicaid.
• Strong interpersonal skills and ability to build rapport with diverse stakeholders.
• Excellent communication skills, both verbal and written.
• Proficiency in Microsoft Office suite and other relevant software applications.
• Ability to work independently and collaboratively in a fast-paced environment.

Note: The specific responsibilities and qualifications may vary depending on the healthcare organization's size, structure, and specialty focus. Adaptations to the job description may be necessary to align with organizational needs and requirements.