Provider Relations Representative, Sr. jobs in Allentown, PA

Provider Relations Representative, Sr. 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. May provide guidance or expertise to less experienced representatives. Being a Provider Relations Representative, Sr. typically requires a bachelor's degree. Typically reports to a supervisor or manager. The Provider Relations Representative, Sr. gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Relations Representative, Sr. typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

Recently Added Provider Relations Representative, Sr. jobs

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Provider Service Helpline Representative
  • Health Partner Plans, Inc.
  • East Stroudsburg, PA FULL_TIME
  • Why Choose Jefferson Health Plans?
    We are an award-winning, not-for-profit health maintenance organization. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.
    We offer Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We’re also committed to boosting the health of our community through outreach, education, and events. Founded over 35 years ago, Jefferson Health Plans continually develops new ways to encourage better health outcomes and has received national recognition for our innovations in managed care.
    While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.
    Perks of Jefferson Health Plans and why you will love it here:
    • Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing
    • Flextime and Work-at-Home Options
    • Benefits & Wellness Program including generous Time Off
    • Impact on the communities we service.
    We are seeking a talented and enthusiastic Provider Service Help Line Representative to join our team!
    Respond to providers’ incoming calls and take appropriate action to resolve providers’ issues across lines of business. Educate callers about the plan and retain providers using effective customer service techniques to provide a high level of service. Dual role supporting incoming calls from both member’s and providers.
    As the Provider Service Help Line Representative your daily duties may include:
    • Provide accurate and complete information in response to providers’ inquiries, complaints and/or problems.
    • Collaborate with internal departments to facilitate resolutions to provider issues and concerns.
    • Respond to provider related calls in a courteous, professional & efficient manner providing timely follow-up to requests for information and service.
    • Respond to provider inquiries regarding member eligibility, Third Party Liability (TPL) and benefits.
    • Document all calls in accordance with departmental requirements.
    • Review claims in the core processing system and provide high level claim status to provider inquiries.
    • Review claims details and submit for reconsideration as appropriate.
    • Provide member authorization statuses upon request.
    • Confirm which services require prior authorization upon request.
    • Educate providers on Provider Portal capabilities (i.e. reset passwords and duplicate EOP request)
    • Reference and review the providers contract and provide basic information to contractual inquires.
    • Operate telephone systems effectively and efficiently, following established protocols for security, transfer and information exchange with the Utilization Management, Pharmacy and Claims Services departments.
    • Meet individual performance standards, such as satisfactory volume of calls, and telephone and paperwork audits.
    • Advise providers upon request of their Jefferson Health Plans network participation status, status of their credentialing application and fee schedule rate inquiries.
    • Educate providers on Jefferson Health Plans programs and policies, as appropriate.
    • Maintain resources relevant to the job, such as the provider manual and the department’s training manual to ensure accurate responses to provider inquiries.
    • Participate in ongoing projects, training, staff and/or committee meetings.
    • Perform other job duties as necessary.
    Qualifications
    • High school diploma or 3 years of Equivalent work experience required.
    • Minimum of 2 years of call center experience, inbound/outbound telephone experience or equivalent face to face customer service experience within a provider-facing environment.
    Skills, We Value:
    • Demonstrated organizational, analytical, written, and verbal communication skills and interpersonal skills required.
    • Claims experience preferred. Possess the ability to work independently and as part of a team.
    • Working knowledge of HCPCs and ICD-10 coding preferred.
    • Medicaid, CHIP, Medicare knowledge is a plus.
    • Strong relational database experience, Proficient in Microsoft Outlook and Excel and working knowledge of Microsoft Word
  • 28 Days Ago
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Sr HR Representative
  • Supply Chain
  • Bethlehem, PA FULL_TIME
  • *Must be bilingual in English and SpanishSr HR Representative Do you enjoy working in a team environment providing strategic counsel and advisory services to leaders on business and people related iss...
  • 1 Month Ago
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Customer Relations Representative - State Farm Agent Team Member
  • Richard D'Antonio - State Farm Agent
  • Souderton, PA FULL_TIME
  • Position Overview Are you outgoing and customer-focused? Do you enjoy working with the public? If you answered yes to these questions, working for a State Farm independent contractor agent may be the ...
  • 13 Days Ago
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Customer Relations Representative - State Farm Agent Team Member
  • Korey Pepkowski - State Farm Agent
  • Sellersville, PA FULL_TIME
  • Position Overview: Are you outgoing and customer-focused? Do you enjoy working with the public? If you answered yes to these questions, working for a State Farm independent contractor agent may be the...
  • 15 Days Ago
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Customer Relations Representative - State Farm Agent Team Member
  • Richard D'Antonio - State Farm Agent
  • Harleysville, PA FULL_TIME
  • Position Overview Are you outgoing and customer-focused? Do you enjoy working with the public? If you answered yes to these questions, working for a State Farm independent contractor agent may be the ...
  • 2 Days Ago
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Customer Relations Representative - State Farm Agent Team Member
  • Jim Gardner - State Farm Agent
  • Allentown, PA FULL_TIME
  • Position Overview Are you outgoing and customer-focused? Do you enjoy working with the public? If you answered yes to these questions, working for a State Farm independent contractor agent may be the ...
  • 11 Days Ago
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0 Provider Relations Representative, Sr. jobs found in Allentown, PA area

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Community Relations Representative
  • AmeriHealth Caritas
  • Hazleton, PA
  • Your career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are pa...
  • 4/23/2024 12:00:00 AM
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Universal Member Service Representative (PC 1573)
  • Members1st
  • Bethlehem, PA
  • ** Universal Member Service Representative (PC 1573)** **Job Category****:** Members Services / Sales **Requisition Numb...
  • 4/21/2024 12:00:00 AM
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FT Customer Service Representative - Work From Home>
  • ARIVE
  • Bethlehem, PA
  • [Call Center / Remote] Anywhere in U.S. / Up to $50K per year / Medical, Dental and Vision / 401k match / PTO - As a Cus...
  • 4/20/2024 12:00:00 AM
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Customer Service Representative (Loan Consultant II)
  • Lendmark Financial Services, LLC
  • Hokendauqua, PA
  • At Lendmark Financial Services, we believe the success of our company is specifically attributable to the quality of our...
  • 4/19/2024 12:00:00 AM
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Customer Service Representative I
  • Healthnetworklabs
  • Allentown, PA
  • Customer Service Representative I Tracking Code HNL 21-525 ( Part-Time, 24 Hours Per Week, Evening Shift, 5 Days a Week ...
  • 4/19/2024 12:00:00 AM
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Senior Customer Care Representative
  • Health Network Laboratories Limited Partnership
  • Allentown, PA
  • Senior Customer Care Representative Tracking Code HNL 21-538 ( Full-Time, 40 Hours Per Week, Day Shift, 5 days a week W/...
  • 4/19/2024 12:00:00 AM
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Associate District Service Manager
  • Steris plc.
  • Bethlehem, PA
  • Job Title: Associate District Service Manager Description: At STERIS, we help our Customers create a healthier and safer...
  • 4/19/2024 12:00:00 AM
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Customer Service Representative
  • Evonik
  • Allentown, PA
  • **Customer Service Representative** **Location:** Allentown, PA, US **VACANCY REFERENCE NUMBER 155400** **Customer Servi...
  • 4/18/2024 12:00:00 AM
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About Allentown, Pennsylvania

Allentown (Pennsylvania Dutch: Allenschteddel) is a city located in Lehigh County, Pennsylvania, United States. It is Pennsylvania's third most populous city and the 231st largest city in the United States. As of the 2010 census, the city had a total population of 118,032 and is currently the fastest growing city in all of Pennsylvania. It is the largest city in the metropolitan area known as the Lehigh Valley, which had a population of 821,623 residents as of 2010[update]. Allentown constitutes a portion of the New York City Combined Statistical Area and is the county seat of Lehigh County. ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$72,095 to $89,407
Allentown, Pennsylvania area prices
were up 1.5% from a year ago
View detail

What does a Provider Relations Representative, Sr. do?

Provider Relations Representative, Sr. in Kingsport, TN
A job as a Provider Relations Representative falls under the broader career category of Business Operations Specialists, All Other.
February 18, 2020
Provider Relations Representative, Sr. in Sioux City, IA
The PR Rep serves as a liaison between contracted payers, providers and ancillary providers to promote superior customer service and seamless programs.
February 16, 2020
Provides telephonic provider education to new providers.
February 14, 2020
Provider Relations Representative, Sr. in Buffalo, NY
This position provides on-going communication, in-service, orientation, and direction to these contracted provider offices.
February 03, 2020