Provider Relations Representative, Sr. jobs in Wilkes Barre, 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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Member Relations Representative
  • Health Partner Plans, Inc.
  • Scranton, PA FULL_TIME
  • Why Choose Jefferson Health Plans?
    We are an award-winning, not-for-profit health maintenance organization. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.
    We offer Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We’re also committed to boosting the health of our community through outreach, education, and events. Founded over 35 years ago, Jefferson Health Plans continually develops new ways to encourage better health outcomes and has received national recognition for our innovations in managed care.
    While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.
    Perks of Jefferson Health Plans and why you will love it here:
    • Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing
    • Flextime and Work-at-Home Options
    • Benefits & Wellness Program including generous Time Off
    • Impact on the communities we service.
    We are seeking a talented and enthusiastic Member Relations Representative to join our team!
    The Medicare Member Relations Representative (Tier 1) promotes a positive image of Jefferson Health Plans via telephone, utilizing each contact as an opportunity to educate members and providers about the plan, effectively handling inbound, outbound and outreach calls to and from members, providers, and other areas internal and external to Jefferson Health Plans. This role requires a basic understanding of the concepts of Medicaid, Medicare and CHIP lines of business and demonstrating skills in assisting the members/providers with the reason for the call as outlined in the primary responsibilities or escalating the call as appropriate to the Tier II level of agents. Ensure member retention as well as advise them of specific eligibility requirements to assure continued customer satisfaction.
    As the Member Relations Representative your daily duties may include:
    • Educate members and providers about Jefferson Health Plan with the intent of retaining members and providing a high level of customer service.
    • Respond to member and member-related calls in a courteous, professional & efficient manner providing timely follow-up to requests for information and service.
    • Answer eligibility and benefits questions, assuring that members receive service, use the plan correctly and gain a high level of satisfaction with the plan.
    • Assist members with demographic changes, updates or as required coordinating the changes with the County Assistance Office, CMS, Office of CHIP or the Department of Health and Human Services.
    • Assist members and providers with registering on the member/provider portal and basic self service functions.
    • Assist with requests for ID cards, Welcome Kits, member handbook, provider directory or any other printed material that can be mailed out.
    • Assist with PCP changes and scheduling initial doctor appointments.
    • Collaborate or escalate with internal departments to facilitate resolutions to member’s issues and concerns.
    • Conduct targeted telephonic outreach to members using a prepared script depending on Manager’s direction.
    • Open or build new cases in the care management system and route to the appropriate staff following the direction of the Team Leader, Supervisor or Manager.
    • Research members’ demographics in regulatory system and build cases in Member Relations documentation system by calling hospitals, PCP offices, and/or home care agencies to locate a member’s most recent phone number.
    • Schedule and coordinate transportation need.
    • Utilize the Member Relations translation vendor as indicated by the needs of the member.
    • Refer members to the appropriate Nurse Advice lines and appropriate programs.
    • Maintain accurate data entry into designated software systems.
    • Promote partnership with Quality Management (QM), Utilization Management (UM), Care Coordination, Healthcare Economics and Special Needs Unit (SNU).
    • Maintain call records, logs and other documentation in accordance with departmental requirements.
    • Escalate trends and issues which impact the membership for immediate resolution.
    • Operate all applications and telephone systems effectively and efficiently, following established protocols for security, transfer and information exchange.
    • Participate in appropriate staff meetings and training sessions, reporting on trends and issues which impact members and Jefferson Health Plans as a whole.
    • Attend monthly meetings as scheduled.
    • Adhere to daily schedule, responding to emails timely, use of appropriate call center status, confidentiality of information, and general business protocols.
    • Perform other clerical and support tasks as assigned.
    • Other duties as assigned.
    Qualifications
    • High School Diploma or 3 years of Equivalent work experience required.
    • Excellent communication and interpersonal skills required.
    • Minimum of 1 years of call center experience, inbound/outbound telephone experience or equivalent face to face customer service experience preferred.
    • Healthcare experience is preferred. Managed care experience is a plus.
    Skills, We Value:
    • Excellent written and verbal communications skills.
    • Bilingual a plus
    • Basic typing and computer skills required. Experience using Microsoft Word and Excel is desirable.
    • Ability to work independent of direct supervision, but also must be able to work within a Team.
  • 22 Days Ago

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Customer Relations Representative - State Farm Agent Team Member
  • Noreen Thomas - State Farm Agent
  • Clarks Summit, PA FULL_TIME
  • Position Overview Successful State Farm Agent is seeking a qualified professional to join their winning team for the role of Customer Relations Representative - State Farm Agent Team Member. We seek a...
  • 19 Days Ago

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Customer Relations Representative - State Farm Agent Team Member
  • Lisa Zavada-Rizzo - State Farm Agent
  • Harveys Lake, PA FULL_TIME
  • Position Overview State Farm Insurance Agent located in harveys lake , PA is seeking an outgoing, career-oriented professional to join their team. As a State Farm team member for Lisa Zavada-Rizzo - S...
  • 20 Days Ago

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Customer Relations Representative - State Farm Agent Team Member
  • Len Mudlock - State Farm Agent
  • SUGARLOAF, PA PART_TIME
  • ROLE DESCRIPTION: As a Customer Relations Representative - State Farm Agent Team Member with Len Mudlock - State Farm Agent, you will generate the kind of exceptional client experiences that reinforce...
  • 1 Day Ago

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Customer Relations Representative - State Farm Agent Team Member
  • Beth Moloughney - State Farm Agent
  • Mount Pocono, PA 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 ...
  • 9 Days Ago

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Customer Relations Representative - State Farm Agent Team Member
  • Darrin Herbener - State Farm Agent
  • Sugarloaf, PA FULL_TIME
  • Benefits: 401(k) Bonus based on performance Paid time off Training & development Competitive salary ROLE DESCRIPTION: As a Customer Relations Representative - State Farm Agent Team Member with Darrin ...
  • 10 Days Ago

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0 Provider Relations Representative, Sr. jobs found in Wilkes Barre, PA area

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Customer Service Representatives Bloomsburg, PA 955 Columbia Blvd 17815
  • Pizza Hut Shop
  • Bloomsburg, PA
  • 955 Columbia Blvd **Bloomsburg, PA 17815** **Customer Service Representatives** **Description:** Gather round the good s...
  • 3/28/2024 12:00:00 AM

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FT Customer Service Representative - Work From Home>
  • Dick's Sporting Goods, Inc.
  • Wilkes Barre, PA
  • [Customer Support / Remote] - Anywhere in U.S. / Up to $46.2K per year / Benefits - As a Customer Service Rep you'll: As...
  • 3/27/2024 12:00:00 AM

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Medical Equipment Customer Service Representative
  • Rotech Healthcare Inc.
  • Dickson City, PA
  • OVERVIEW: Rotech Healthcare Inc. is a national leader in providing ventilators, oxygen, sleep apnea treatment, wound car...
  • 3/27/2024 12:00:00 AM

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Customer Service Representative
  • Azek Co.
  • Scranton, PA
  • ** Customer Service Representative** **Job Category****:** Customer Service **Requisition Number****:** CUSTO01466 Showi...
  • 3/26/2024 12:00:00 AM

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Client Services Representative
  • Baker Tilly US, LLP
  • Clarks Summit, PA
  • Overview: Baker Tilly US, LLP (Baker Tilly) is a leading advisory CPA firm, providing clients with a genuine coast-to-co...
  • 3/26/2024 12:00:00 AM

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Account Specialist Customer Care (Sun-Thursday: day shift) Hazleton, PA, United States
  • Highwood USA
  • Hazleton, PA
  • **Account Specialist Customer Care (Sun-Thursday: day shift)** Hazleton, PA, United States Full Time **Position Summary:...
  • 3/26/2024 12:00:00 AM

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Creative Marketing Representative/Market Analyst
  • van Hoekelen Greenhouses, Inc.
  • McAdoo, PA
  • THE BASICS Maintain website content. Create and maintain an annual catalog. Improve SEO for online presence. Email marke...
  • 3/24/2024 12:00:00 AM

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Customer Experience Associate
  • Weis
  • Tunkhannock, PA
  • Overview Looking for a company that treats associates with respect, understanding, and appreciation? Looking for a compa...
  • 3/24/2024 12:00:00 AM

Wilkes-Barre (/ˈwɪlksˌbɛər/ or /-bɛəri/) is a city in the Commonwealth of Pennsylvania and the county seat of Luzerne County. It is one of the principal cities in the Scranton–Wilkes-Barre–Hazleton, PA Metropolitan Statistical Area. Located at the center of the Wyoming Valley, it is second in size to the nearby city of Scranton. The Scranton–Wilkes-Barre–Hazleton, PA Metropolitan Statistical Area had a population of 563,631 as of the 2010 Census, making it the fourth-largest metro/statistical area in the state of Pennsylvania. Wilkes-Barre and the surrounding Wyoming Valley are framed by the P...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$66,064 to $81,928
Wilkes Barre, Pennsylvania area prices
were up 1.5% 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