Provider Relations Representative, Sr. jobs in Westfield, MA

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 Experience Representative
  • Health New England
  • Springfield, MA FULL_TIME
  • Purpose


    The Provider Experience Representative Contributes to the overall success of the Provider Excellence ensuring specific individual goals, plans, and initiatives are executed / delivered in support of the team’s business strategies and objectives. Ensures all activities conducted are in compliance with governing regulations, internal policies and procedures.


    Accountabilities


    • Champions a customer focused culture to deepen client relationships and leverage broader Health New England’s relationships, systems and knowledge.

    • Understand how Health New England’s culture and the CX Promise should be considered in day-to-day activities and decisions.

    • Actively pursues effective and efficient operations of their respective areas in accordance with Health New England’s Values, its Code of Conduct and the Associate Handbook, while ensuring the adequacy, adherence to and effectiveness of day-to-day business controls to meet obligations with respect to operational, compliance, and conduct.

    • Champions a high performance environment and contributes to an inclusive work environment.

    • Develops and maintains positive working relationships with key contacts at selected Provider organizations, such as hospitals, large regional practitioners groups, and other providers as identified and assigned for the purpose of resolving provider issues, addressing concerns/inquiries, evaluating requests, and identifying training and education opportunities.

    • Adheres to established processes and procedures for addressing or reassigning provider inquiries, requests, or grievances and aids in: determining root causes, developing standard and non-standard resolution options, relaying expected timelines for resolution, and executes provider communication protocols.

    • Participates, as requested, in functional workgroups such as Provider Joint Operating Committees (JOC), provider renegotiation meetings, and regulatory and accreditation meetings

    • Assists in the development of, and regularly reviews, the Provider Support team on-line resources and training aids to ensure timely and accurate information - recommends updates as necessary.

    • Serves as a resource for the Provider Support team with regards to clarifying Departmental processes and procedures, escalated provider issues, exception requests, and grievances.

    • Assists in broad issue identification and resolution by reviewing team reports to identify trends and collaborate with the appropriate HNE functional areas for viable short and long term solutions to avoid reoccurrences and increase provider satisfaction.


    Position: : Provider Experience Representative /Provider Experience


    Reporting Relationships (Job Titles only)

    Primary Manager:

    (include secondary Manager if applicable)


    • Manager of Provider Experience


    Direct Reports:

    • None


    Shared Reports (solid/dotted if applicable):

    • None


    External/Internal Contacts

    Internal

    • Provider Contracting

    • Provider Operations

    • Legal

    • Claims & Claims Operations (Configuration)

    • Healthcare Services


    External

    • Hospitals and individual/group practices

    • Department of Insurance

    • Department of Health

    • Healthcare Trade Organizations


    Education / Experience / Other Information (include only those that are specific to the role)

    Bachelor’s degree or an equivalent combination of education and experience in business or a related field with a minimum of three years health care/provider servicing experience
    • Demonstrated achievement and progressive responsibilities in the area of provider servicing and issue resolution
    • Knowledge of managed care financing, provider reimbursement, and claims payment mechanisms
    • Working understanding of NCQA and HEDIS and government regulations
    • Broad based knowledge of Medicare, Medicaid, and commercial product offerings
    • Proficiency with Microsoft applications

  • 1 Month Ago

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Senior Labor Relations Representative (Hybrid)
  • UMass Amherst
  • Amherst, MA FULL_TIME
  • About UMass Amherst UMass Amherst, the Commonwealth's flagship campus, is a nationally ranked public research university offering a full range of undergraduate, graduate and professional degrees. The ...
  • 13 Days Ago

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Customer Relations Representative - State Farm Agent Team Member
  • Jennifer Lamphere - State Farm Agent
  • Stafford, CT FULL_TIME
  • Position Overview: Are you outgoing and customer-focused? Do you enjoy working with the public? If you answered yes to these questions, working for a State Farm independent contractor agent may be the...
  • 10 Days Ago

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Customer Relations Representative - State Farm Agent Team Member
  • Jo Ann Walk - State Farm Agent
  • Enfield, CT FULL_TIME
  • Position Overview Are you outgoing and customer-focused? Do you enjoy working with the public? If you answered yes to these questions, working for a State Farm independent contractor agent may be the ...
  • 14 Days Ago

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Guest Relations Team Member
  • Six Flags New England
  • Agawam, MA FULL_TIME
  • Six Flags Entertainment Corporation is the world's largest regional theme park company with 26 parks across North America. For more than 55 years, Six Flags has entertained millions of families with w...
  • 20 Days Ago

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Operations Coord for College Relations
  • Mount Holyoke College
  • South Hadley, MA FULL_TIME
  • Job no: 493795 Work type: Staff Full-time, Staff Full-Time (Hybrid) Location: South Hadley, MA, Hybrid - South Hadley, MA Categories: Administrative/ Executive/ Office Support Position Type: Staff Ful...
  • 20 Days Ago

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0 Provider Relations Representative, Sr. jobs found in Westfield, MA area

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Sr. Application Developer
  • CVS Health
  • Hartford, CT
  • Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to ever...
  • 3/28/2024 12:00:00 AM

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Sr. Product Manager, Application, Network and Cloud Infrastructure
  • Riverbed Technology, Inc.
  • Agawam, MA
  • Riverbed. Empower the Experience: Riverbed transforms data into actionable insights and accelerates performance so organ...
  • 3/27/2024 12:00:00 AM

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Sr. Director, Data Architecture
  • The Travelers Indemnity Company
  • Hartford, CT
  • Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this...
  • 3/27/2024 12:00:00 AM

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Senior Manager, Technical Program Management - Enterprise Data
  • Capital One
  • Springfield, MA
  • Center 3 (19075), United States of America, McLean, Virginia Senior Manager, Technical Program Management - Enterprise D...
  • 3/26/2024 12:00:00 AM

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Sr. Distinguished Applied Researcher
  • Capital One
  • Springfield, MA
  • Center 1 (19052), United States of America, McLean, Virginia Sr. Distinguished Applied Researcher Overview: At Capital O...
  • 3/26/2024 12:00:00 AM

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Sr Design Engineer (Gas Turbine MRB)
  • Quest Global
  • Windsor, CT
  • Job Description Job Description Quest Global is an organization at the forefront of innovation and one of the world’s fa...
  • 3/26/2024 12:00:00 AM

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Senior Manager, Technical Program Manager - Machine Learning
  • Capital One
  • Springfield, MA
  • Center 1 (19052), United States of America, McLean, Virginia Senior Manager, Technical Program Manager - Machine Learnin...
  • 3/25/2024 12:00:00 AM

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Senior Health, Safety and Environmental Specialist REMOTE, CANADA
  • Careerbuilder
  • Hartford, CT
  • Senior Health, Safety and Environmental Specialist REMOTE, CANADA Senior Health, Safety and Environmental Specialist REM...
  • 3/25/2024 12:00:00 AM

Westfield is located at 42°7′46″N 72°44′46″W / 42.12944°N 72.74611°W / 42.12944; -72.74611 (42.129492, −72.745986). It is bordered on the north by Southampton, on the northeast by Holyoke, on the east by West Springfield, on the southeast by Agawam, on the south by Southwick, on the southwest by Granville, on the west by Russell, and on the northwest by Montgomery. Westfield is split into the "South Side" and the "North Side" by the Westfield River, and the northwestern section of town is known as Wyben. According to the United States Census Bureau, the city has a total area of 47.4 square ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$74,550 to $92,451
Westfield, Massachusetts area prices
were up 1.6% 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