Provider Relations Representative, Sr. jobs in Jacksonville, FL

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/Provider Enrollment Specialist.
  • Ed Fraser Memorial Hospital
  • Macclenny, FL FULL_TIME
  • At BCMS, the Provider Enrollment Specialist ensures that all providers comply with relevant state and federal regulatory associations. This position is responsible for keeping records related to insurance contracts and medical staff credentials. This includes constant contact with staff, insurance companies, and partnering credentialing teams to ensure they have all the necessary documents and are informed of any changes in contracts and policies.

    The Provider Relations/Enrollment Specialist is key to a successful credentialing/enrollment process. Along with other credentialing duties, this position is also directly responsible for preparing and submitting applications and supporting documentation to enroll individual physicians and other healthcare providers with payers. The specialist also processes new applications, revalidations, ERN/ERA applications, and updates rosters.

    Major Areas of Responsibility:

    • Monitor provider/staff credentials and licenses.
    • Advise providers on renewal procedures.
    • Keep records in licenses, credentials, and insurance contracts.
    • Receive and analyze all verified documentation for Providers and execute provider enrollment with carriers.
    • Process new enrollments and revalidations, update rosters, and ensure all Providers are linked to their appropriate sites.
    • Shares essential updates with key stakeholders and internal teams as necessary in weekly summary reports or other correspondence.
    • Collaborate regularly with the Billing team on enrollment issues to investigate and correct.
    • Work closely and effectively with Human Resources and Providers.
    • Correspond with the credentialing team within all healthcare partnerships, providers, and program directors as necessary to provide constant, up-to-date status as needed.
    • Establish a relationship with the carrier credentialing representative and keep up with any changes or updates from the carriers.
    • Maintain an organized filing system of all providers' credentialing information in a safe and secure environment to remain in compliance with HIPAA.
    • Update Provider's CAQH accounts.
    • Work in PECOS and NPPES, as necessary.
    • Performs all other duties as assigned.

    Education:

    • High School Diploma required.
    • BS preferred.
    • Knowledge of Meditech Expanse a plus.

    Work Experience:

    • A minimum of 3 years of experience with provider enrollment processing/credentialing experience is required.
    • Detailed, oriented, and organized.
    • Experience working with insurance carriers and the provider enrollment portals.
    • Excellent problem-solving and critical-thinking skills.
    • Able to perform with autonomy.
    • Excellent communication skills across all levels in the agency.
    • Familiarity with NCQA standards and how to apply them.
    • Proficient with basic computer systems, networks, and software applications, such as the Microsoft Office Suite (Outlook, Word, and Excel).

    Licensure/Certification/Affiliation:

    • Certified Provider Credentialing Specialist (CPCS) certification through the National Association of Medical Staff Services (NAMSS) is a plus.

    Skills, Knowledge, and Abilities:

    • Creative and critical thinking
    • Interpersonal skills that establish productive working relationships with a multidisciplinary team and administrative support
    • High-level ability to use an electronic medical record.
    • Ability to communicate effectively in both written and verbal form to patients, public, medical staff, and physicians.
    • Experience working in a diverse environment.

    Job Type: Full-time

    Pay: $22.00 - $25.00 per hour

    Expected hours: 40 per week

    Benefits:

    • 401(k)
    • 401(k) matching
    • AD&D insurance
    • Dental insurance
    • Employee assistance program
    • Health insurance
    • Life insurance
    • Paid time off
    • Vision insurance

    Schedule:

    • On call

    Ability to Relocate:

    • Macclenny, FL 32063: Relocate before starting work (Required)

    Work Location: In person

  • 7 Days Ago

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Sales Relations Representative
  • Unit Pro Marketing
  • Jacksonville, FL FULL_TIME
  • Job Description Job Description We pride ourselves on our commitments to our ethos, clients, and the Jacksonville community. You don’t just have to trust us, the results speak for themselves. We’re a ...
  • 4 Days Ago

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Patient Relations Representative
  • Alfa Dental Management
  • Jacksonville, FL FULL_TIME
  • Who is Alfa Dental Management? Alfa Dental Management is a dental management group based in Jacksonville, FL supporting 8 dental offices in North Florida. We provide hands-on organizational support wh...
  • 26 Days Ago

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Guest Relations Representative
  • The Kress Brunswick
  • Brunswick, GA PART_TIME
  • Guest Relations Representative The Kress is looking for highly motivated, organized candidates with excellent people skills to serve as guest relations representatives. The guest relations representat...
  • 2 Months Ago

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Caregiver
  • Sr Companies Llc
  • Jacksonville, FL FULL_TIME
  • Summary: Responsible for enhancing and improving the SRIM experience specifically in heartfelt care for our residents and their families. Demonstrates and promotes SRIM’s core value of the golden rule...
  • 18 Days Ago

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Home Health Office Manager- Orange Park
  • Sr Companies Llc
  • Orange, FL FULL_TIME
  • DUTIES Oversee the operations of the office, including maintaining current employee personnel files, answering all phone calls, preparing, and maintaining the Agency's payroll system, and compiling st...
  • 18 Days Ago

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0 Provider Relations Representative, Sr. jobs found in Jacksonville, FL area

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Customer Service Representative (Hybrid Remote)
  • McKesson Cork
  • Jacksonville, FL
  • Effective Date: February 22, 2017 . **Your Consent** *Google Analytics* We may use Google Analytics to measure how you i...
  • 3/28/2024 12:00:00 AM

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Remote Call Center Representative
  • Contemporary Staffing Solutions
  • Jacksonville, FL
  • Job Description Job Description We are seeking a Call Center Representative to join our team! You will be responsible fo...
  • 3/27/2024 12:00:00 AM

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Member Services Representative Planet Fitness Orange Park
  • Planet Fitness
  • Jacksonville, FL
  • Job Summary The Member Services Representative will be responsible for creating a positive member experience by providin...
  • 3/27/2024 12:00:00 AM

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Client Service Associate Manager
  • Mosaic North America
  • Jacksonville, FL
  • Summary Description of this Position: The Client Service Associate Manager will sell the company’s complete product and ...
  • 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

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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, 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

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Local Success Coach (Part Time Sales & Customer Service Coordinator)
  • GOAUPAIR OPERATIONS LLC
  • Jacksonville, FL
  • Job Description Job Description Work from home as part-time Local Success Coach (LSC)! Great part-time position for anyo...
  • 3/26/2024 12:00:00 AM

Jacksonville is the most populous city in Florida, the most populous city in the southeastern United States and the largest city by area in the contiguous United States. It is the seat of Duval County, with which the city government consolidated in 1968. Consolidation gave Jacksonville its great size and placed most of its metropolitan population within the city limits. As of 2017 Jacksonville's population was estimated to be 892,062. The Jacksonville metropolitan area has a population of 1,523,615 and is the fourth largest in Florida. Jacksonville is centered on the banks of the St. Johns ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$67,846 to $84,137
Jacksonville, Florida area prices
were up 1.5% 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