Provider Relations Representative, Sr. jobs in Boise, ID

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)

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Provider Relations Network Manager- Idaho
  • Mount Carmel Health System
  • Boise, ID FULL_TIME
  • Employment Type:
    Full time
    Shift:

    Description:

    The Provider Relations & Network Manager is responsible for a full range of provider relations and service interactions in MediGold's Idaho market, including: contracting and recruitment, issue resolution and escalations, strategy development and execution, education, and retaining MediGold Contracted Providers. This position serves as the primary point of contact for the Providers and will require extensive relationship building, driving the resolution of complex issues, and MediGold brand building. The individual will also assist the Director for Provider Contracting and Network Development to develop provider collaborations that ensure network growth and quality/efficiency targets.

    Responsibilities

    • Recruit providers to build a cost effective and high quality provider network within MediGold guidelines.
    • Serve as the MediGold point of contact within the Provider network; Act as the MediGold Subject Matter Expert and brand ambassador.
    • Addresses customer complaints by directly handling the issue, working with the correct department(s) to resolve, or escalating as required.
    • Engage Providers to develop, coordinate, and lead training and distribution of materials.
    • Proactively drive communications with Providers via telephone/email and onsite visits.
    • Collaborates with the Director - Provider Contracting and Network Development to develop communication goals, strategies, and plans.
    • Negotiates provider contracts within MediGold guidelines and financial standards.
    • Collaborates with the Managers of Member and Provider Communications to oversee the completion of all provider communication content and materials.
    • Manages and works with other internal partners to facilitate provider Joint Operating Committee (JOC) Meetings.
    • Develops, implements, and manages policies, and procedures as assigned.
    • Assists Director and/or Sr. Director with the Medical Delivery Systems budget.
    • Manages successful implementation of provider contracts, including interpretation of payment and reimbursement terms.
    • Maintains excellent working relationships with MediGold's provider network, internal department management, other business partners, and Mount Carmel Health System related entities.
    • Exhibits a professional appearance and demeanor.
    • Travel to regional client locations and corporate office as required.
    • Use of personal vehicle for Provider visits required.
    • All other duties as assigned.

    Requirements

    • Education: Bachelor's degree in Healthcare Administration, Finance, related field or equivalent experience.
    • Experience: Minimum five years of experience with a Health Plan or Health Provider. Prior contracting and network development experience highly preferred
    • Knowledge of physician claims coding and Provider reimbursement payment methodologies; Ability to interpret Provider contracts
    • Willingness to be the point of contact for the MediGold brand within the Provider network
    • Establish and maintain relationships with Providers to ensure quality and satisfaction of services provided
    • Capacity to address complex problems including claims issues and customer service complaints; work with other departments to achieve resolution of the issues
    • Demonstrated ability to identify areas of opportunity within Provider networks for improving overall efficiency and quality
    • Working knowledge of protocols and procedures of Centers For Medicare and Medicaid Services
    • Proven ability to work effectively with internal and external multi-disciplinary teams across all levels of the organization
    • Proven track record of managing multiple priorities and executing tasks within tight timeframes
    • Experience in identifying and executing process improvement needs
    • Must possess a high degree of motivation, initiative, and organization ability
    • Valid driver's license

    Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.

    Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, physical disability or any other classification protected under local, state or federal law.

    Our Commitment to Diversity and Inclusion


    Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

  • 4 Days Ago

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Customer Relations Representative - Entry Level
  • T & D Solutions ID
  • Boise, ID FULL_TIME
  • Our goal is to increase our client's current customer base and brand reputation across the region. Our team's commitment to fostering an environment of inclusive collaboration and comradery is directl...
  • 10 Days Ago

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Dental Assistant
  • Compass Medical Provider, LLC
  • Boise, ID CONTRACTOR,PART_TIME
  • Compass Medical Provider is seeking an experienced Dental Assistant to provide precise dental exams and treatment on Thursdays for the Idaho National Guard located in Boise, ID. Dental Exams include u...
  • 1 Day Ago

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Customer Relations Representative - State Farm Agent Team Member
  • Corry Perkins - State Farm Agent
  • Boise, ID 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...
  • 19 Days Ago

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Customer Relations Representative - State Farm Agent Team Member
  • Chris Baldwin - State Farm Agent
  • Mountain Home, ID 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 ...
  • 20 Days Ago

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Customer Relations Representative - State Farm Agent Team Member
  • Monte Folsom - State Farm Agent
  • Star, ID 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...
  • 3 Days Ago

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0 Provider Relations Representative, Sr. jobs found in Boise, ID area

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Gust Service Representative
  • Bubbly Paws
  • Meridian, ID
  • **Gust Service Representative** Guest Services Meridian, Idaho Compensation **13-15/hr** We are looking for our next out...
  • 3/28/2024 12:00:00 AM

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Patient Service Representative Float Pool Full-Time Rotating
  • Trinity Health Corporation
  • Boise, ID
  • Employment Type: Full time Shift: Rotating Shift Description: At Saint Alphonsus Health System, we are looking for peopl...
  • 3/27/2024 12:00:00 AM

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FT Customer Service Representative - Work From Home>
  • Dick's Sporting Goods, Inc.
  • Boise, ID
  • [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

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Remote Customer Service Representative - Idaho
  • 4Patriots
  • Boise, ID
  • 4Patriots, LLC, is a fast-growing, nationally recognized direct-to-consumer brand focused on offering high-quality produ...
  • 3/27/2024 12:00:00 AM

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Client Representative
  • NWM Inc
  • Boise, ID
  • Job Description Job Description Client Representative What do YOU want, what's important to YOU? More growth? More oppor...
  • 3/27/2024 12:00:00 AM

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Customer Service/Advertising Representative
  • Endless Air
  • Meridian, ID
  • Job Description Job Description We are a fast-paced Northwestern Distribution center looking to expand our team. We stri...
  • 3/27/2024 12:00:00 AM

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Call Center Representative
  • Apex Systems
  • Boise, ID
  • Customer (Call Center)Service Representative - Boise, Idaho Looking for candidates with call center/customer service exp...
  • 3/26/2024 12:00:00 AM

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Field Services Representative II Installed Support
  • Builders FirstSource
  • Meridian, ID
  • Ignite your career at Builders FirstSource, America's largest supplier of building materials, value-added components and...
  • 3/25/2024 12:00:00 AM

Boise (/ˈbɔɪsi/ (listen)) is the capital and most populous city of the U.S. state of Idaho, and is the county seat of Ada County. Located on the Boise River in southwestern Idaho, the population of Boise at the 2010 Census was 205,671, the 99th largest in the United States. Its estimated population in 2016 was 223,154. Boise is in southwestern Idaho, about 41 miles (66 km) east of the Oregon border, and 110 miles (177 km) north of the Nevada border. The downtown area's elevation is 2,704 feet (824 m) above sea level. Most of the metropolitan area lies on a broad, flat plain, descending to the ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$66,452 to $82,409
Boise, Idaho area prices
were up 2.5% 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