Provider Relations Representative, Sr. jobs in Bloomfield, NJ

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)

F
Recruitment & Credentialing Provider Relations Specialist
  • First Managed Care Option
  • Parsippany, NJ FULL_TIME
  • PRIMARY FUNCTION

    Responsible for the procedures associated with recruitment of Auto/Pip experienced providers into network, which includes receipt, review, and processing of credentialing application and to serve as liaison between the providers and FMCO. As such, responsible for recruitment, communication, and resolution of questions and issues between the provider and the Company.

    RESPONSIBILITIES

    Recruitment

    · Identify and communicate with potential providers via telephone and written correspondence.

    · Ensure provider experience and understanding of Auto/Pip

    · Attend meetings at providers’ offices relating to recruitment process.

    · Maintain and update electronic log of potential providers’ current status in recruitment process.

    · Ensure that all documentation is completed to facilitate a smooth credentialing process.

    · Provide weekly written report of all activities.

    Credentialing

    · Interact with potential providers.

    · Distribute, assist in completion and collect all credentialing materials.

    · Support and facilitate the credentialing process; inform the provider of credentialing status.

    · Data entry of provider information into Provider Database.

    · Prepare necessary reports for review of Quality Management Committee.

    · Assist in collecting information for appeals and sanctioning processes.

    Provider Relations

    · Identify and interact with potential providers and educate regarding FMCO policy and procedure.

    · Act as a liaison between the providers and FMCO.

    · Distribute and assist in completion of provider applications and contracts.

    · Conduct on-site visits to provider locations, as necessary.

    · Ensure that providers are adequately supplied with all necessary forms.

    · Maintain the Provider Database.

    · Assist in the resolution of provider issues.

    · Maintain the Provider QA Database.

    · Communicate with the Quality assurance supervisor, as necessary.

    · Prepare reports for the Quality Management Committee.

    · Assist in provider education program.

    · Attend in-services to update skills and information in changes in plans or procedures.

    EDUCATION, EXPERIENCE, SKILLS

    · Bachelors Degree preferred.

    · Previous experience in medical field desirous.

    · Previous experience with NJ PIP Fee Schedule and rules desirous.

    · Must exercise sound judgment, and possess ability to work with minimum supervision.

    · Excellent verbal and written communication skills.

    · Excellent negotiation skills.

    · Computer proficiency.

    · Ability to prioritize duties.

    First Managed Care Option, Inc., is an Equal Opportunity Employer and takes pride in maintaining a diverse environment. We do not discriminate in recruitment, hiring, training, promotion or any other employment practices for reasons of race, color, religion, gender, national origin, age, sexual orientation, marital or veteran status, disability, or any other legally protected status.

  • 3 Days Ago

E
Customer Relations Representative
  • Extremity Medical
  • Parsippany, NJ FULL_TIME
  • Job Description Job Description In this position, the Customer Relations Representative (CRR), will primarily be responsible for daily communication with customers, sales personnel, distributor busine...
  • 4 Days Ago

W
Customer Relations Representative
  • Wurth Group of North America Inc.
  • Wayne, NJ FULL_TIME
  • Key Responsibilities Order entry, update, and execution Expedition of Purchasing orders with suppliers Deliver excellent customer service Contribute to high performance as measured by KPIs (i.e. fill ...
  • 1 Month Ago

W
Customer Relations Representative
  • Wurth International Trading Ameriva
  • Wayne, NJ FULL_TIME
  • Key Responsibilities Order entry, update, and execution Expedition of Purchasing orders with suppliers Deliver excellent customer service Contribute to high performance as measured by KPIs (i.e. fill ...
  • 1 Month Ago

S
Sr. Patient Accounts Representative
  • St. Josephs Health
  • Paterson, NJ FULL_TIME
  • Overview St. Joseph’s Healthcare System is recognized for the expertise and compassion of its highly skilled and responsive staff. The combined efforts of the organization’s outstanding physicians, su...
  • Just Posted

A
Sr. Patient Contact Representative - Blended
  • Alpaca Audiology
  • Parsippany, NJ FULL_TIME
  • Alpaca Audiology is looking for an individual who has proficiently mastered every aspect of a Contact Center: Inbound, Outbound, Lead Generation, Social Media, and Retention. Remote Position may be av...
  • 2 Days Ago

Filters

Clear All

  • Filter Jobs by companies
  • More

0 Provider Relations Representative, Sr. jobs found in Bloomfield, NJ area

N
Client Relations Representative (remote)
  • Newport Associates
  • Brooklyn, NY
  • A Travel Client Relations Coordinator at the entry level is responsible for assisting with client communications and ens...
  • 3/28/2024 12:00:00 AM

T
Customer Service Representative (30hrs) Newark Springfield Avenue
  • TD Bank Group
  • Newark, NJ
  • We are working to deliver a legendary mobile experience. If your experience is less than optimal, please visit us on a d...
  • 3/28/2024 12:00:00 AM

W
Safety Airline Ramp Service Supervisor
  • Worldwide Flight Services
  • Newark, NJ
  • About WFS Join our Worldwide Flight Services family and contribute to the timely delivery of cargo shipment, luggage, bu...
  • 3/27/2024 12:00:00 AM

D
FT Customer Service Representative - Work From Home>
  • Dick's Sporting Goods, Inc.
  • East Orange, NJ
  • [Customer Support / Remote] - Anywhere in U.S. / Up to $46.2K per year / Benefits - As a Customer Service Rep you'll: As...
  • 3/27/2024 12:00:00 AM

P
Employee Relations Representative-Contract/Temporary
  • Port Authority of New York & New Jersey
  • Jersey City, NJ
  • Description Responsibilities: This is a contract/temporary position. This position is located at 2 Montgomery Street, Je...
  • 3/26/2024 12:00:00 AM

S
Regional Executive Director
  • Staffosaurus
  • Newark, NJ
  • About the job Regional Executive Director About Us Our program is built upon evidence-based treatment principles. Our mi...
  • 3/25/2024 12:00:00 AM

E
Customer Relations Representative
  • Extremity Medical
  • Parsippany, NJ
  • Job Description Job Description In this position, the Customer Relations Representative (CRR), will primarily be respons...
  • 3/24/2024 12:00:00 AM

D
FT Customer Service Representative - Work From Home>
  • Dick's Sporting Goods, Inc.
  • Bloomfield, NJ
  • [Customer Support / Remote] - Anywhere in U.S. / Up to $46.2K per year / Benefits - As a Customer Service Rep you'll: As...
  • 3/24/2024 12:00:00 AM

Bloomfield is a township in Essex County, New Jersey, United States. As of the 2010 United States Census, the township's population was 47,315, reflecting a decline of 368 (-0.8%) from the 47,683 counted in the 2000 Census, which had in turn increased by 2,622 (+5.8%) from the 45,061 counted in the 1990 Census. It surrounds the Bloomfield Green Historic District. According to the United States Census Bureau, the township had a total area of 5.328 square miles (13.801 km2), including 5.304 square miles (13.738 km2) of land and 0.024 square miles (0.063 km2) of water (0.46%). Silver Lake (2010 t...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$82,274 to $102,030
Bloomfield, New Jersey area prices
were up 1.5% from a year ago

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