Provider Relations Representative, Sr. jobs in West Chester, PA

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/Mailroom- DE
  • Gainwell Technologies LLC
  • Newark, DE FULL_TIME
  • Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.


    Summary

    A minimum of 1 year’s experience in a call center environment is required. Experience in health/human services and knowledge of Medicaid preferred. Complete pre and post-enrollment site visits according to customer guidelines. Provide excellent customer service primarily by telephone to Medicaid Providers. Assist providers with submission of enrollment applications which includes, appropriate taxonomies, application type, and troubleshooting application process. Follow Customer approved policy regarding submission and processing of enrollment applications. Conduct appropriate research and follow-up for prompt resolution.

    Your role in our mission

    This is an important position in Gainwell’s commitment to helping clients deliver better health and human services outcomes.

    Complete pre and post-enrollment site visits by customer policy. Accurately document the results of the site visit and maintain the record in the provider file. This position will involve travel to provider offices within 50 miles of the Delaware border. Anticipated travel is less than 50%. In addition to completing the site visits, support of the Provider Enrollment call center is expected.

    Work efficiently in a high-volume call center while maintaining a professional, polite manner. Assist callers with enrollment-related questions; accurately interpret policy, analyze customer inquiries, and determine steps for resolution. Keep resource information up to date and organized. Document calls clearly and consistently in the computer system. Conduct appropriate research and follow-up for prompt resolution of disputed enrollments. Relay information to appropriate departments and personnel using established communication channels and procedures. Must be able to type and talk at the same time and navigate through multiple screens Ability to maintain confidentiality and adhere to HIPAA requirements. At times, it may be necessary to schedule meetings with providers to assist with the enrollment process.

    Process provider enrollment applications within the SLA. Review enrollment applications against customer policy to ensure appropriate enrollment in DMAP programs. Work with the customer to review applications as outlined in the policy.

    Promptly respond to written inquiries from providers and customers regarding enrollment questions/concerns.

    What we're looking for

    • Experience working in a metric-driven work environment.
    • Experience using an auto-answer system.
    • Experience working in the Healthcare Industry
    • Experience working with Medicaid or Medicare
    • Experience meeting specific service level agreements (SLAs)
    • Experience in provider enrollment or provider credentialing
    • 2 or more years of customer service experience in any industry
    • Knowledge of basic help desk software, computer software, and Microsoft Office applications
    • Strong problem-solving skills to bring inquiries to effective resolution
    • Strong customer service skills with an emphasis on written and oral communication to respond to inquiries professionally
    • Ability to understand your role on a team and identify the correct stakeholders to consult to resolve client inquiries

    What you should expect in this role

    • Participates productively as a member of a team.
    • Completes tasks beyond the general support level.
    • Accepts instruction and direction from leadership. Ability to manage tasks and assignments without detailed direction.
    • Identifies, prioritizes, and resolves some issues independently, and escalates more complex questions or issues appropriately.
    • Complies with contract requirements, business unit rules, and related legal regulations.
    • 50% will be helping the mailroom out when needed.

    #LI-ON-SITE #LI-JW1


    The pay range for this position is $29,100.00 - $41,600.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.


    We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.


    Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

  • 1 Month Ago

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Associate Relations Representative
  • Impact Solutions Inc
  • Milford, DE FULL_TIME
  • This position is responsible and accountable for establishing a working relationship with managers, supervisors and hourly production associates in the processing plant to foster an environment of coo...
  • 23 Days Ago

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Corporate Relations Representative
  • Sunday Breakfast Mission
  • Wilmington, DE FULL_TIME
  • MinistryHub is honored to partner with Sunday Breakfast Mission in their search for a Corporate Relations Representative. Please direct all applications through MinistryHub and any inquiries to hello@...
  • 8 Days Ago

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Office Administrator: The Office of U.S. Representative Chrissy Houlahan, PA-06
  • Office of U.S. Representative Chrissy Houlahan
  • West Chester, PA PART_TIME
  • Job Summary: Office Administrator: The Office of U.S. Representative Chrissy Houlahan, PA-06 is seeking a customer service oriented, high performing individual to serve as an Office Administrator in o...
  • 5 Days Ago

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Associate Relations Representative (HR Generalist)
  • Surf Search Inc
  • Milford, DE FULL_TIME
  • Requirements : Bachelor’s degree in Business Administration, Human Resources, Labor Relations or related field plus 3 5 years of experience is required. Additionally, individual should have : Proven s...
  • 19 Days Ago

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Associate Relations Representative (HR Generalist)
  • Impact Solutions Inc
  • Milford, DE FULL_TIME
  • Requirements: Bachelor’s degree in Business Administration, Human Resources, Labor Relations or related field plus 3 - 5 years of experience is required. Additionally, individual should have:• Proven ...
  • 9 Days Ago

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0 Provider Relations Representative, Sr. jobs found in West Chester, PA area

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Customer Relations Representative (96290) Full Time | Philadelphia Location - Philadelphia, PA, 19154 (Remote) chevron_right
  • Westinghouse Lighting Corporation
  • Philadelphia, PA
  • Job Location Philadelphia Location - Philadelphia, PA Education Level High School *Westinghouse Lighting is a family-own...
  • 3/29/2024 12:00:00 AM

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Member Services Representative- PT
  • Planet Fitness Inc.
  • West Chester, PA
  • Job Summary The Member Services Representative will be responsible for creating a positive member experience by providin...
  • 3/29/2024 12:00:00 AM

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Customer Relations Representative
  • Wendy Phung - Allstate Insurance
  • Philadelphia, PA
  • Job Description Job Description Benefits/Perks: Paid time off (vacation and/or sick days) Growth potential Salary plus c...
  • 3/28/2024 12:00:00 AM

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Client Relations Representative
  • RSP Events
  • Philadelphia, PA
  • Job Description Job Description We are seeking an enthusiastic and dynamic individual to join our team as a Retail Marke...
  • 3/27/2024 12:00:00 AM

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Member Services Representative - Afternoons/Night 2pm-10pm
  • Planet Fitness Inc.
  • West Chester, PA
  • 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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Customer Service Representative
  • Chapman Windows Doors & Siding
  • West Chester, PA
  • Job Description Job Description We are currently looking for a dynamic individual to fill the Customer Service Represent...
  • 3/27/2024 12:00:00 AM

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Member Services Representative PT
  • Planet Fitness
  • West Chester, PA
  • The Member Services Representative will be responsible for creating a positive member experience by providing a superior...
  • 3/27/2024 12:00:00 AM

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Collections Analyst
  • Citadel Frederal Credit Union
  • Exton, PA
  • Job Description Job Description The Collections Analyst is responsible for mitigating loss to the Credit Union by contac...
  • 3/25/2024 12:00:00 AM

West Chester is a borough and the county seat of Chester County, Pennsylvania, in the U.S. state of Pennsylvania. The population was 18,461 at the 2010 census. Much of the West Chester University of Pennsylvania North Campus and the Chester County government are located within the borough. The center of town is located at the intersection of Market and High Streets. West Goshen Township borders West Chester to the north, south, and east, while East Bradford Township borders West Chester to the west. The borough straddles the Brandywine Creek and Chester Creek watersheds. It is located 25 mile...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$74,782 to $92,739
West Chester, Pennsylvania area prices
were up 1.0% 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