Provider Relations Representative, Sr. jobs in Idaho

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
  • Scott Blanton - State Farm Agent
  • Montpelier, ID FULL_TIME
  • Benefits: Bonus based on performance Company parties Competitive salary Opportunity for advancement Parental leave Free food & snacks ROLE DESCRIPTION: As a Customer Relations Representative with Scot...
  • 20 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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Guest Relations Representative
  • Six Flags Great Adventure
  • Jackson, NJ
  • Assist Guests with questions, comments, concerns they may have about their experience while visiting Six Flags. Resolve ...
  • 3/29/2024 12:00:00 AM

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Customer Relations Representative
  • Sutherland Global
  • COVID-19 Update: Sutherland is committed to ensuring a safe working environment for our people, their families, and the ...
  • 3/29/2024 12:00:00 AM

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Guest Relations Representative
  • Great Escape
  • Queensbury, NY
  • What You Will Be Doing Assist Guests with the purchase of in park Admission and Group Sales Tickets as well as On-line T...
  • 3/27/2024 12:00:00 AM

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Donor Relations Representative
  • Christus Health
  • Irving, TX
  • Description Summary: Responsible for gift processing and donor relations including: responding to all donor inquiries, r...
  • 3/27/2024 12:00:00 AM

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Customer Relations Representative
  • Tampa Bay Partnership
  • **Customer Relations Representative** CUSTOMER RELATIONS in St Petersburg, FL, United States St Petersburg, FL, United S...
  • 3/27/2024 12:00:00 AM

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Customer Relations Representative
  • MaxLite
  • Anaheim, CA
  • Customer Relations Representative Customer Relations Job Type Full-time Description **Customer Relations Representative*...
  • 3/27/2024 12:00:00 AM

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Customer Relations Representative
  • Smooth Vision Marketing Inc
  • Jacksonville, FL
  • Job Description Job Description We are looking for a Customer Relations Representative with experience in the restaurant...
  • 3/26/2024 12:00:00 AM

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Customer Relations Representative
  • Vespa Consulting Inc
  • Jacksonville Beach, FL
  • Job Description Job Description At Vespa Consulting we are dedicated to developing solutions that make it easy for custo...
  • 3/26/2024 12:00:00 AM

Idaho (/ˈaɪdəhoʊ/ (listen)) is a state in the northwestern region of the United States. It borders the state of Montana to the east and northeast, Wyoming to the east, Nevada and Utah to the south, and Washington and Oregon to the west. To the north, it shares a small portion of the Canadian border with the province of British Columbia. With a population of approximately 1.7 million and an area of 83,569 square miles (216,440 km2), Idaho is the 14th largest, the 12th least populous and the 7th least densely populated of the 50 U.S. states. The state's capital and largest city is Boise. Idaho p...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$66,252 to $82,161

Provider Relations Representative, Sr. in Duluth, MN
Held meetings with providers to review new policies, products and issue resolution.
January 14, 2020
Provider Relations Representative, Sr. in Norwich, CT
The continued upward spiral in health care costs has challenged sponsors, providers and payers of health benefits to deliver high quality care in the most cost-effective manner possible.
January 21, 2020
Provider Relations Representative, Sr. in Poughkeepsie, NY
The specific duties of customer service representatives vary by industry.
December 25, 2019