Provider Relations Representative, Sr. jobs in Greensburg, 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)

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Director, Provider Relations
  • naviHealth, Inc.
  • Pittsburgh, PA FULL_TIME
  • Overview

    Job Summary

    The Director, Provider Relations is responsible for leading a team that spans across markets, lines of business and clients. This position assists the Market President in developing and executing the strategy and performance of the provider network and network outcomes. This is a collaborative role requiring critical thinking skills, independence, leadership, a strategic mindset, and attention to detail.

     

    Responsibilities

    • Work closely with Sales to support service and product revenue growth, customer acquisition and customer satisfaction.
    • Partner with Executive Directors and Director of Clinical Operations to support network initiatives.
    • Work closely with Data Management teams on claims processing, resolution issues, and provider performance tool enhancements to better serve the PAC environment.
    • Support companywide initiatives, marketing the naviHealth brand and evolving Provider Operations.
    • Work closely with Product Teams to ensure new developments align with provider expectations.
    • Analyze, summarize, and supports claims-based change management performance at acute and PAC levels anticipating and creating actionable plans that drive network performance change at the client level supporting the Market President and Director, Clinical Operations’ internal KPI goals.
    • Analyze, summarize, and create action plans using the semi-annual Provider Satisfaction Survey results.
    • Remain current on all regulatory changes in the acute and post-acute care environment.
    • Drive performance and execute on strategic initiatives within the provider network.
    • Understand and influence the impact of regional/national providers in the market.
    • Guide pay for performance modeling for clients.
    • Collaborate with clients to develop or narrow networks to high performing.
    • Speak to naviHealth products such as provider portal, nH Perform, SADB.
    • Direct the activities of Network Managers including hiring, onboarding, and professional development activities.
    • Develop, analyze, and deliver RFI/Service Capability requests/ Collaboration Agreements.
    • Support clients in contract negotiation activity and re-writes.
    • Serve external customers - oversee provider advisory councils and manage provider grievances/complaints.
    • Represent the Network/Provider Engagement Team in requests for strategic alliances with providers as well as trade agencies.
    • Perform other duties and responsibilities as required, assigned, or requested.

     

    Qualifications

    • Bachelor’s degree in Business or a Health Care related field with sales and marketing focus preferred; Master’s Degree preferred
    • At least 10 years of relevant experience required, including 5 years in a management/leadership role 
    • Strong analytical skills
    • Effective negotiation and influencing skills
    • Detail-oriented
    • Self-starter with effective communication skills
    • Ability to complete initiatives with minimal supervision
    • Excellent presentation skills with high Emotional Intelligence
    • Ability to build and foster relationships inside and outside the organization
    • Ability to independently plan, organize and prioritize work
    • Ability to influence others
    • Ability to educate
    • Willingness to work toward team objectives
    • Ability to manage direct reports/team members effectively
    • Ability to make appropriate organizational determinations in accordance with naviHealth standards of practice independently and timely
    • Experienced in managed care, health plan operations in provider contracting, customer service or provider relations preferred
    • Strong brand promotion and management skills
    • Proficiency with Microsoft Office applications
    • Strong knowledge in Acute and Post-Acute Care Continuum  
    • Ability to travel extensively may be required

     

    Work Conditions and Physical Requirements

    • Ability to establish a home office workspace
    • Ability to manipulate laptop computer (or similar hardware) between office and site settings
    • Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard time period
    • Ability to communicate with clients and team members including use of cellular phone or comparable communication device
    • Ability to remain stationary for extended time periods (1-2 hours)
    • Travel requirements
      • Ability to travel to markets supported by naviHealth to recruit and monitor field staff, and to interact with clients and physician groups on program protocols and outcomes up to 50% of the time

    About naviHealth

    naviHealth is improving the healthcare experience for seniors to live more fulfilling lives. For nearly a decade, naviHealth has been a trusted partner for the nation’s top health plans, health systems, and at-risk physician groups navigating the shift from volume to value. Powered by a predictive technology and decision support platform that provides clinicians and care teams with evidence-based protocols, naviHealth’s high-touch, proven care model fully supports patients from pre-acute through to the home. With naviHealth, patients can enjoy more days at home, and healthcare providers and health plans can significantly reduce costs specific to unnecessary care and readmissions. For more information about naviHealth, visit navihealth.com.

     

    Our Purpose

    Improving the healthcare experience for seniors to live a more fulfilling life

     

    Our Values

    Rooted in respectGuided by purpose Devoted to service Energized by impact

     

    The above statements are intended to describe the general nature and level of work performed by colleagues assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications. naviHealth reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.

     

    naviHealth 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, protected veteran status, or any other protected status under applicable laws and will not be discriminated against on the basis of disability.

  • 22 Days Ago

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Provider Relations Coordinator
  • Pantherx Specialty LLC
  • Pittsburgh, PA FULL_TIME
  • 7,000 Diseases - 500 Treatments - 1 Rare PharmacyPANTHERx is the nation’s largest rare disease pharmacy, and we put the patient experience at the top of everything that we do. If you are looking for a...
  • 16 Days Ago

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Sr. Employee Relations Specialist
  • HRT Solutions
  • Weirton, WV FULL_TIME
  • Senior Employee Relations Specialist Location: Weirton, WV Work Type: Hybrid (on-site in Weirton, WV 3 days/week) Summary: Form Energy is a U.S. technology and manufacturing company that is developing...
  • 22 Days Ago

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Provider & Community Relations Coordinator (Greene County)
  • UPMC
  • Pittsburgh, PA FULL_TIME
  • UPMC Community Care Behavioral Health is seeking a full-time Provider & Community Relations Coordinator to support the Network Management Department in the Greene County area! The Provider & Community...
  • 1 Day Ago

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Carrier Relations Representative
  • PGT Trucking, Inc.
  • Aliquippa, PA FULL_TIME
  • Carrier Relations Representative With more than 40 years of transportation experience, PGT Trucking Inc. is a leader in flatbed shipping solutions with the best drivers, and office talent in the indus...
  • 20 Days Ago

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Member Relations Representative - Bilingual
  • Health Partner Plans, Inc.
  • Pittsburgh, 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 celebrate...
  • 21 Days Ago

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0 Provider Relations Representative, Sr. jobs found in Greensburg, PA area

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Franchise Hotel - General Manager
  • IHG
  • Mount Pleasant, PA
  • **Your web browser (Chrome 88) is out of date.** **Franchise Hotel - General Manager** **Hotel Brand:** Holiday Inn Expr...
  • 3/28/2024 12:00:00 AM

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Customer Support Representative II (French Speaking) - REMOTE WORK AVAILABLE
  • Management Science Associates, Inc.
  • Pittsburgh, PA
  • Customer Support Representative II (French Speaking) - REMOTE WORK AVAILABLE Tracking Code 2021040 Job Description **Ove...
  • 3/28/2024 12:00:00 AM

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Assistant Service Manager
  • Pep Boys Inc
  • Pittsburgh, PA
  • **** **Assistant Service Manager** **Assistant Service Manager** **Requisition ID:** 100193 **Category:** Service Desk *...
  • 3/28/2024 12:00:00 AM

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Customer Relations Representative
  • Cashdollar Insurance Agency Inc
  • North Versailles, PA
  • Job Description Job Description Are you outgoing and customer-focused? Do you enjoy working with the public? If you answ...
  • 3/27/2024 12:00:00 AM

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Customer Service Representative - Levin
  • HCB Technologies Ltd
  • Monroeville, PA
  • **Customer Service Representative - Levin** Our successful team at BNT Levin is looking for a motivated and passionate t...
  • 3/27/2024 12:00:00 AM

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Teller Customer Service Representative
  • WBMM Money Center Inc
  • Monroeville, PA
  • Job Description Job Description We are seeking a Teller Customer Service Representative to join our team! You will be re...
  • 3/26/2024 12:00:00 AM

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FT Customer Service Representative - Work From Home>
  • Dick's Sporting Goods, Inc.
  • Latrobe, PA
  • [Customer Support / Remote] - Anywhere in U.S. / Up to $46.2K per year / Benefits - As a Customer Service Rep you'll: As...
  • 3/26/2024 12:00:00 AM

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Customer Service Representative
  • Party Savvy
  • Monroeville, PA
  • Job Description Job Description Benefits: 401(k) 401(k) matching Dental insurance Employee discounts Health insurance Pa...
  • 3/26/2024 12:00:00 AM

Greensburg is a city in and the county seat of Westmoreland County, Pennsylvania, United States, and a part of the Pittsburgh Metro Area. The city lies within the Laurel Highlands and the ecoregion of the Western Allegheny Plateau. The city is named after Nathanael Greene, a major general of the Continental Army in the American Revolutionary War. The population was 14,892 at the 2010 census. Located 30 miles southeast of Pittsburgh, Greensburg is a major business, academic, tourism and cultural center in Western Pennsylvania. It is evident as the city's population doubles during work hours. ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$68,085 to $84,434
Greensburg, Pennsylvania area prices
were up 1.9% 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