Provider Relations Representative, Sr. jobs in Pennsylvania

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 (Hybrid)
  • UPMC
  • Somerset, PA FULL_TIME
  • UPMC Community Care Behavioral Health is seeking a full-time Provider Relations Representative to support the Network Management Department in Somerset, PA!

    The Provider Relations Representative will work daylight hours, Monday through Friday, in a hybrid work structure! This role will primarily work from home, but will have weekly office time during the first few weeks of training. Additionally, there may be some occasional required office visits for meetings and/or other departmental needs.

    The Provider Relations Representative will initiate and develop working relationships with external providers, managing a primary caseload of assigned providers, for whom they are the principal point of contact, and covering other caseloads occasionally as circumstances require. This role ensures that providers are fully educated as to appropriate policies and procedures for conducting business with Community Care, and also presents comprehensive knowledge of the authorizations and claims functions, credentialing requirements, the application and contracting process, and other topics of general and specific interest to the provider. 

    The ideal candidate for this position will be well-versed in the differences between commercial, Medical Assistance, and all other products, with an emphasis on differences in the providers' obligations for each. Behavioral health services experience is preferred, as well!

    Responsibilities:

    • Ensure that providers meet the clinical needs of enrolled consumers while continuing to comply with service delivery standards.
    • Share responsibilities with other department personnel for answering the provider line.
    • Establish excellent working relationships with a defined panel of providers.
    • Work with the Director, Provider Relations, and other staff, as appropriate, to develop the provider manuals and handbooks.
      • This process will involve provider input, as well as advice from appropriately designated advisory groups.
    • Develop and implement an Action Plan in response to each provider service call.
    • Participate in the development and delivery of provider orientation, and follow-up as needed with assigned group.
    • Work with colleagues on the development of provider newsletters and other educational materials.
    • Ensure that assigned providers have current copies of all relevant educational materials, including the billing handbook and provider manual.
      • Responsible for accurate interpretation of materials to providers in a consistent fashion and for identifying and proposing solutions to problems as they arise.
    • Work as a member of the Provider Relations staff, ensuring that corrective action plans are implemented and result in complete problem resolution.
    • Responsive to deadlines, completing assignments within deadlines at least 95% of the time.
    • Meet or exceed specified goals for the number of provider service meetings on a quarterly basis.
    • Balance time and effort spent on external provider servicing with in-office responsibilities.
    • Coordinate service schedule with other Service Reps to ensure adequate and consistent phone coverage.
    • Implement the use of quality indicators for use within the network, including working with providers as necessary to ensure full understanding and compliance.
    • Manage supplemental service enrollment process for his/her designated panel of providers.
    • Understand and communicate the details of the authorization process and Community Care's procedures for delivering the authorizations to providers.
  • 7 Days Ago

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Provider Relations Representative
  • Community Behavioral Health.
  • Philadelphia, PA FULL_TIME
  • Position Overview: The Provider Relations Representative acts as the CBH primary point person to CBH’s provider network for education, support and resolution of Provider inquiries. The Provider Relati...
  • 14 Days Ago

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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 developi...
  • 23 Days Ago

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Provider Relations Coordinator
  • Clark Resources
  • Philadelphia, PA FULL_TIME
  • Knowledge, Skills, and Abilities Required: Position requires (a) Bachelor’s degree in Marketing, Communications, or Healthcare-related field and at least 3 years’ work experience in provider relations...
  • 1 Day 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...
  • 17 Days Ago

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Hospice Provider Relations (Community Liaison) - Philadelphia County
  • Crossroads Hospice & Palliative Care
  • Philadelphia, PA FULL_TIME
  • The Provider Relations (Community Liaison) is a results-driven professional who supports the interdisciplinary hospice team by building relationships with doctors, facilities, and other healthcare org...
  • 25 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

Pennsylvania (/ˌpɛnsɪlˈveɪniə/ (listen) PEN-sil-VAY-nee-ə), officially the Commonwealth of Pennsylvania, is a state located in the northeastern and Mid-Atlantic regions of the United States. The Appalachian Mountains run through its middle. The Commonwealth is bordered by Delaware to the southeast, Maryland to the south, West Virginia to the southwest, Ohio to the west, Lake Erie and the Canadian province of Ontario to the northwest, New York to the north, and New Jersey to the east. Pennsylvania is the 33rd-largest state by area, and the 6th-most populous state according to the most recent of...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$71,214 to $88,314

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