Provider Relations Representative, Sr. jobs in Easton, 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
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.
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.
- 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.
- 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
- 22 Days Ago
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
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 ...
- 7 Days Ago
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...
- 8 Days Ago
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 ...
- 5 Days Ago
Customer Relations Representative - State Farm Agent Team Member
- Ryan O'Shurak - 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...
- 5 Days Ago
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0 Provider Relations Representative, Sr. jobs found in Easton, PA area
Customer Service Representative
- Barentz
-
Hampton, NJ
- **Customer Service Representative** *We are looking to add to our team a full-time **Customer Service Representative** w...
- 4/16/2024 12:00:00 AM
Universal Member Service Representative (PC 1573)
- Members1st
-
Bethlehem, PA
- ** Universal Member Service Representative (PC 1573)** **Job Category****:** Members Services / Sales **Requisition Numb...
- 4/16/2024 12:00:00 AM
Registered Nurse, Patient Service Representative
- St. Lukes Health Network
-
Bethlehem, PA
- Registered Nurse, Patient Service Representative page is loaded **Registered Nurse, Patient Service Representative** **R...
- 4/16/2024 12:00:00 AM
Remote Customer Service Representative - Pennsylvania
- 4Patriots
-
Allentown, PA
- 4Patriots, LLC, is a fast-growing, nationally recognized direct-to-consumer brand focused on offering high-quality produ...
- 4/15/2024 12:00:00 AM
Customer Service Representative
- Walmart
-
Easton, PA
- **Job Title: Customer Service Representative (Walmart)** **Job Summary:** As a Customer Service Representative at Walmar...
- 4/14/2024 12:00:00 AM
Customer Service Representative
- Hawthorne Gardening Company
-
Phillipsburg, NJ
- Customer Service Representative in Phillipsburg, NJ at Hawthorne Gardening Co. Location * **Location:** **Experience:** ...
- 4/14/2024 12:00:00 AM
Senior Customer Care Representative
- OraSure Technologies, Inc.
-
Bethlehem, PA
- ** Senior Customer Care Representative** ** OraSure Technologies Bethlehem, Pennsylvania, United States (On-site)** ** P...
- 4/14/2024 12:00:00 AM
ED Patient Access Representative, 2nd Shift
- St. Luke's University Health Network
-
Bethlehem, PA
- St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most ...
- 4/12/2024 12:00:00 AM
About Easton, Pennsylvania
Easton is a city in and the county seat of Northampton County, Pennsylvania, United States. The city's population was 26,800 as of the 2010 census. Easton is located at the confluence of the Delaware River and the Lehigh River, roughly 55 miles (89 km) north of Philadelphia and 70 miles (110 km) west of New York City.
Easton is the easternmost city in the Lehigh Valley, a region of 731 square miles (1,893 km2) that is home to more than 800,000 people. Together with Allentown and Bethlehem, the Valley embraces the Allentown-Bethlehem-Easton metropolitan area, including Lehigh, Northampton, an...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$71,952 to $89,229
Easton, Pennsylvania area prices
were up 1.5% from a year ago
were up 1.5% from a year ago
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