Provider Relations Representative, Sr. jobs in Miami, 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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Representative, Provider Relations
  • Independent Living Systems
  • Miami, FL FULL_TIME
  • ABOUT US

    Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.

     

    Position Summary

    The Provider Relations Representative is responsible for developing, maintaining and servicing high quality, marketable and satisfied provider network within an assigned geographic area. This position is expected to build and sustain strong working relationships with cross functional departments and Providers in the assigned geographic area. The Provider Relations Specialist helps Providers in the assigned geographic area operate successfully within our healthcare delivery model by providing strategic education on the special needs of the enrollees, comprehensive understanding of ILS contracts and the PSN plans quality initiatives. 

     

    Essential Functions 

    1. Educating the providers to ensure they understand the contract and the Medicaid initiatives regarding this population and the contract requirements of the PSN.
    2. Educating the providers to the mandated best practices for their provider type and the quality measures of the PSN.
    3. Coordinates with other PSN internal departments to resolve questions or issues regarding prior authorizations, claims submission or payment issues.    Conducts new provider orientations and ongoing education to providers and their staffs regarding claims, payments, eligibility, utilization management or any other questions impacting provider performance.
    4. Conducts provider meetings to share and discuss issues of concern, troubleshoots for issue resolution, and implements an escalation process for discrepancies.
    5. Handles or ensures appropriate scheduling, agenda, materials, location, of provider meetings as needed. 
    6. Collaborates with Credentialing Department to ensure provider data is correct and include any needed updates.
    7.  Assists providers to obtain and complete Provider Change Forms as needed.
    8.  Provides information and participates in management meetings as requested.
    9.  Regularly meets with other Provider Specialists to create, revise and adjust strategy for assigned Provider Groups to meet overall performance goals.

     

    Education and Experience

    • BA or BS degree or a minimum of five years’ experience as a Provider Relation Specialist with a Health Plan
    • Bilingual in Spanish and English                                                                                                              

    Required Skills

    •   Ethical Conduct. 
    •   Strategic-Critical Thinking. 
    •   Leadership.
    •   Decision Making. 
    •   Financial Management. 
    •   Communications Proficiency
    •   Presentations Skills                                                                                                                                                                                          

     

    EEO STATEMENT 

    In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

      

  • 4 Days Ago

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Provider Relations Representative
  • ttg Talent Solutions
  • Miami, FL FULL_TIME
  • Provider Relations Representative Full time - Monday- Friday Miami, Florida The Provider Relations Representative is responsible for fostering a strong and satisfied network of healthcare providers in...
  • 7 Days Ago

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Provider Relations Representative
  • Cano Health
  • Miami, FL FULL_TIME
  • Overview Cano Health fosters a culture driven by providing superior primary care services in the communities we serve, while forming lifelong bonds with our members. Guided by our mission to improve t...
  • 15 Days Ago

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Account Executive, Provider Relations
  • Independent Living Systems
  • Miami, FL FULL_TIME
  • ABOUT USJoin us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiari...
  • 11 Days Ago

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Provider Relations Specialist
  • Genuine Health Group LLC
  • Miami, FL FULL_TIME
  • Summary:The Provider Relations Specialist is responsible for developing, maintaining, and servicing a high quality, marketable and satisfied provider network within an assigned geographic area. In add...
  • 1 Month Ago

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Sr. Manager, Media Relations
  • Red Bull North America
  • Miami, FL FULL_TIME
  • The Hispanic Media Relations Senior Manager is responsible for the editorial communication of national and globally relevant stories from the World of Red Bull via our top Hispanic Media that Matter b...
  • 19 Days Ago

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

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Customer Service Representative
  • Arona Home Essentials
  • Miami, FL
  • Arona Home Essentials has a long legacy as an industry leader, with continued growth regardless of the economy. We are b...
  • 3/28/2024 12:00:00 AM

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Patient Access Representative 1 (On-site)- Miami BeachPart time
  • University of Miami Miller School of Medicine
  • Miami Beach, FL
  • Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click he...
  • 3/28/2024 12:00:00 AM

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Customer Service - Phone Admin Representative- Miami International Airport
  • Enterprise Holdings
  • Miami, FL
  • Overview: The Administrative Representative will provide a high level of customer service by assisting both internal and...
  • 3/28/2024 12:00:00 AM

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Patient Access Representative 1 (On-site)- Miami BeachPart time
  • University of Miami
  • Miami Beach, FL
  • Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click he...
  • 3/28/2024 12:00:00 AM

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Golf Bag Attendant
  • Biltmore Hotel Golf Management LLC
  • Miami, FL
  • Job Type Part-time Description Position Summary To provide the guests with the ultimate first impression of the Biltmore...
  • 3/26/2024 12:00:00 AM

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Vendor Relations Representative
  • ClassWallet
  • Hollywood, FL
  • About ClassWallet ClassWallet is a rapidly growing financial technology company currently selling into the K12 education...
  • 3/25/2024 12:00:00 AM

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Attendant
  • SP Plus Corporation
  • Miami Beach, FL
  • Overview: SP+ is driven by Our Promise, Making Every Moment Matter for a World on the Go. Our team understands that time...
  • 3/25/2024 12:00:00 AM

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Customer Service Representative
  • City of Miami Beach, FL
  • Miami Beach, FL
  • Salary : $2,055.62 - $3,427.78 Biweekly Location : Miami Beach, FL Job Type: Full-time Job Number: 02148 Department: Fin...
  • 3/24/2024 12:00:00 AM

Miami, officially the City of Miami, is the cultural, economic and financial center of South Florida. Miami is the seat of Miami-Dade County, the most populous county in Florida. The city covers an area of about 56.6 square miles (147 km2), between the Everglades to the west and Biscayne Bay on the east; with a 2017 estimated population of 463,347, Miami is the sixth most densely populated major city in the United States. The Miami metropolitan area is home to 6.1 million people and the seventh-largest metropolitan area in the nation. Miami's metro area is the second-most populous metropolis i...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$69,252 to $85,882
Miami, Florida area prices
were up 2.9% 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