Provider Relations Representative, Sr. jobs in Nevada

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 Representative
  • UHS
  • LAS VEGAS, NV FULL_TIME
  • Responsibilities

    Job Summary: Provider Relations Representative is responsible for assisting in the full range of provider relations and service interactions for all lines of business within Prominence Health Plan. Will assist in the design and implementation of programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Supports those who direct and implement strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims; and is responsible for steerage initiatives, site visits, training, educating, and overall communications including portals, webpages, letters, and email messages. Responsible for the oversight and management of Medicare Quality Reporting during each performance year and through the annual reporting periods and ensures resources are in place to complete the annual GPRO reporting requirement.


    Qualifications

    Qualifications and Requirements:

    • BS, Bus Admin, Finance or similar field, or equivalent work history
    • 2 years in HEDIS, ACO, or Care Gap reporting
    • 2 years working with Medicare contracts and regulatory reporting requirements
    • 3 years in managed care or medical insurance.
    • 2 years working in a clinical setting.
    • 1 year in a claims, customer service or provider support role.
    • Excellent oral and written English communication skills including telephone etiquette.
    • Superior interpersonal skills
    • Proficient research, critical-thinking and analytical problem-solving skills
    • Intermediate proficiency with Microsoft Office (Excel, Word, PowerPoint, Outlook).
    • Self-starter and resourceful with ability to execute projects in a fluid and fast paced environment
    • Strong organizational, planning and attention to detail skills.
    • Valid Driver’s License, reliable transportation, and proof of insurance required
    • Requires local travel and occasional out of area overnight travel required.

     

     

    EEO Statement

    All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

     

    We believe that diversity and inclusion among our teammates is critical to our success.

     

    Notice

    At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries.  We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.

  • 18 Days Ago

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Provider Relations Manager
  • Nevada Health Centers, Inc.
  • Carson, NV OTHER
  • Overview Are you looking for a career to be a part of a great culture of support and growth? Then welcome you made it to the job posting for you! At Nevada Health Centers, we look for people who will ...
  • 1 Month Ago

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Provider Relations Manager
  • Nevada Health Centers, Inc.
  • Las Vegas, NV OTHER
  • Overview Are you looking for a career to be a part of a great culture of support and growth? Then welcome you made it to the job posting for you! At Nevada Health Centers, we look for people who will ...
  • 1 Month Ago

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Manager, Provider Relations
  • Prominence Health
  • Reno, NV FULL_TIME
  • Responsibilities: Job Summary: The Provider Relations Manager is responsible for the satisfaction of Prominence Health Plan participating providers through managing a staff of representatives that bui...
  • 2 Months Ago

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Public Relations Representative
  • Orlando Jobs Staffing
  • Carson, NV FULL_TIME
  • Public Relations RepresentativeWe seek an enthusiastic Public Relations Representative to manage our external sales communications. You will promote a positive public image and control the disseminati...
  • 16 Days Ago

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Guest Relations Representative
  • Orlando Jobs Staffing
  • Reno, NV FULL_TIME
  • Guest Relations RepresentativeOur ideal candidate will possess the same passion for the industry and be eager to contribute to the growth and success of the company.The Benefits of Working with us:Sta...
  • 16 Days Ago

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Customer Relations Representative
  • Priam, Inc.
  • Torrance, CA
  • We are a business and marketing firm that was founded almost a decade ago. We are looking to hire a Customer Relations R...
  • 3/28/2024 12:00:00 AM

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Customer Relations Representative
  • California Lifestyle Foundation
  • Concord, CA
  • Are you a dedicated, self-driven individual with a passion for providing outstanding customer support? Do you have a rep...
  • 3/28/2024 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
  • Catalyst Career Group
  • Dallas, TX
  • Job Description Job Description Collaborative. Respectful. A place to dream and do. These are just a few words that desc...
  • 3/27/2024 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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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 ...
  • 3/24/2024 12:00:00 AM

Nevada is almost entirely within the Basin and Range Province, and is broken up by many north-south mountain ranges. Most of these ranges have endorheic valleys between them, which belies the image portrayed by the term Great Basin. Much of the northern part of the state is within the Great Basin, a mild desert that experiences hot temperatures in the summer and cold temperatures in the winter. Occasionally, moisture from the Arizona Monsoon will cause summer thunderstorms; Pacific storms may blanket the area with snow. The state's highest recorded temperature was 125 °F (52 °C) in Laughlin (e...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$72,127 to $89,447

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