Provider Relations Representative, Sr. jobs in Gadsden, AL

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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Executive Vice President, Provider Relations Division
  • Behavioral Health Systems
  • Birmingham, AL FULL_TIME
  • Summary: Under the direction of the CEO, this position is responsible for continued development of national PPO network, PPO rate negotiations, credentialing system, orientation of providers, and provider-related quality assurance. Oversees departmental staff and operations.

    Specific Duties:

    Under the direction of the CEO, and in cooperation with all divisions as deemed appropriate:

    • Oversee development, expansion, and maintenance of PPO network coverage, to include new provider identification, solicitation, and negotiation, as well as client/case-specific provider affiliations. Ensure adherence to established provider fee schedules. Recommend changes as appropriate. Supervise inpatient/outpatient rate negotiations and approval of inpatient contracts.
    • Ensure accurate and complete process of initial and ongoing credentialing of PPO providers, in accordance with established policies and national accreditation standards. Maintain current, accurate and confidential provider files and PPO listings. Assist in URAC accreditation process/preparation as directed.
    • Administer BHS provider orientations, to include individual and regional provider training sessions. Arrange and provide for clinical training/continuing education for providers, as directed. Reimplement the production of a provider newsletter on a regular basis. Handle provider complaints and ensure the retention of all desired PPO providers.
    • Ensure competency and productivity of division staff. Ensure adequate network development efforts are being employed at all times. Ensure adequate network expansion in advance of new client contracts. Work closely with Director, Provider Relations on issues relating to staff hiring and supervision.
    • Ensure the on-going development and maintenance of the computerized provider management system adequate for tracking utilization of resources, credentialing status and claims processing. Ensure adequate provider QA monitoring, to include onsite inspections, and ongoing performance and credentialing reviews, consistent with policies.
    • Provider Relations Division serves in direct support role to the Clinical Division. Assist Clinical Division as directed in client/case-specific provider hook-ups and problem-solving. Assist Clinical Division as directed in arranging for client EAP supervisor and employee training in-services.
    • Assist Clinical Division, BHS ASSIST Division, Behavioral Comp Management, Finance and Corp Relations/Marketing Divisions as requested in support services related to specific or potential client contracts. Assist in preparation of proposals as requested, i.e., network analyses. Assist in new product network development as directed/required.
    • Maintain corporate, departmental and quality assurance policies and procedures. Recommend new policies/procedures as deemed appropriate. Recommend revisions to provider contract forms as appropriate.
    • Participate in on-going marketing and provider relations efforts, as directed. Participate in special projects, on-going research and public relations efforts as appropriate. Maintain information on competition, provider rates by region or city, national statistics and relevant changes in the field. Make recommendations on product line enhancements. Prepare reports as requested.
    • Perform other related duties as directed or deemed appropriate. Attend meetings as requested. Advise CEO on developments in the field.

    Qualifications:

    • Bachelors in related field. Masters degree preferable;
    • Five years provider relations experience required, preferably in PPO or similar setting;
    • Experience in managed care/healthcare benefits environment;
    • Some experience/involvement in mental health field preferred;
    • Familiarity with care management/util. review functions;
    • Proficiency with computerized applications (Word, Access, Excel);
    • Experience in services to business & industry;
    • Experience with contractual terms & rate negotiations;
    • Excellent communication skills (written and oral) and organizational skills;
    • Experience in group presentations/speaking preferable.

  • 2 Days Ago

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Client Relations Representative
  • Avenu Insights & Analytics
  • Birmingham, AL FULL_TIME
  • Job Description Job Description Job Summary : Responsible for providing quality customer support for Clients and Taxpayers through phones, email, and correspondence, new client implementations and at ...
  • 20 Days Ago

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Labor Relations Representative (FT)
  • Cielo Talent
  • Fairfield, AL FULL_TIME
  • 12314U. S. Steel is committed to fostering an inclusive workplace culture and celebrate the diversity of our employees.United States Steel Corporation is actively seeking a Labor Relations Representat...
  • 24 Days Ago

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Labor Relations Representative (FT)
  • United States Steel
  • Fairfield, AL FULL_TIME
  • 12314U. S. Steel is committed to fostering an inclusive workplace culture and celebrate the diversity of our employees.United States Steel Corporation is actively seeking a Labor Relations Representat...
  • 1 Day Ago

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Customer Relations Representative
  • Klutch Konsultants Inc
  • Pelham, AL FULL_TIME
  • As an Entry Level Customer Relations Representative you will be responsible for acquiring and maintaining new accounts for our clients. Our specialty is building relationships with our customers in pe...
  • 9 Days Ago

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Conciliation Specialist
  • US Community Relations Service
  • Birmingham, AL FULL_TIME
  • Duties This job allows telework in accordance with agency policy. The selected applicant will report to their assigned CRS worksite when not teleworking, attending local meetings/events, or on travel....
  • 3 Days Ago

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0 Provider Relations Representative, Sr. jobs found in Gadsden, AL area

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Patient Service Representative (Bilingual)
  • Douglas Medical Center
  • Horton, AL
  • Job Description Job Description The Patient Services Representative (PSR) performs intake, electronic patient management...
  • 3/28/2024 12:00:00 AM

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Branch Manager
  • OneMain (Formerly Springleaf & OneMain Financials).
  • Gadsden, AL
  • PUT YOUR CAREER IN MOTION AS A BRANCH MANAGER As a OneMain Branch Manager, you will create an outstanding environment-a ...
  • 3/28/2024 12:00:00 AM

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Entry Level Sales
  • PRT Financial
  • Gadsden, AL
  • About the Insurance Sales Representative position: We are looking for a competitive Insurance Sales Representative to he...
  • 3/28/2024 12:00:00 AM

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District Sales Manager
  • The Judge Group
  • Gadsden, AL
  • This position is responsible for customer management and administration activities in the assigned district to ensure ou...
  • 3/28/2024 12:00:00 AM

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Continuing Education and Corporate Training Manager I
  • Alabama Community College System
  • Gadsden, AL
  • Salary: See Position Description Location : Gadsden, AL Job Type: Full-Time Job Number: 04244 College/Division: GSCC-400...
  • 3/28/2024 12:00:00 AM

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Delivery Merchandiser Retail - 10 Bay Truck (Non CDL)
  • Buffalo Rock Company
  • Gadsden, AL
  • **Delivery Merchandiser Retail - 10 Bay Truck (Non CDL)** Location **Gadsden, AL** Business Segment **Retail** # of open...
  • 3/28/2024 12:00:00 AM

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District Sales Manager - Gadsden, Alabama
  • Mission Foods
  • Gadsden, AL
  • Job Description Job Description This position is responsible for customer management and administration activities in th...
  • 3/27/2024 12:00:00 AM

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Full Time Assistant Manager - Gadsden AL
  • rue
  • Gadsden, AL
  • Company Description Living Our Values Inclusivity: rue21 embraces all of you. We promote individuality and celebrate our...
  • 3/26/2024 12:00:00 AM

Gadsden is a city in and the county seat of Etowah County in the U.S. state of Alabama. It is located on the Coosa River about 56 miles (90 km) northeast of Birmingham and 90 miles (140 km) southwest of Chattanooga, Tennessee. It is the primary city of the Gadsden Metropolitan Statistical Area, which has a population of 103,931. As of the 2010 census, the population of the city was 36,856, with an estimated population of 35,837 in 2016. Gadsden and Rome, Georgia, are the largest cities in the triangular area now defined by the interstate highways between Atlanta, Birmingham, and Chattanooga. I...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$67,221 to $83,363
Gadsden, Alabama area prices
were up 1.3% 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