Provider Relations Representative
Company: University Health
Location: San Antonio
Posted on: April 26, 2024
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Job Description:
POSITION SUMMARY/RESPONSIBILITIES Provider Relations
Representative works as the primary liaison between Community First
Health Plans and network participants (physicians, providers, and
administrators) of the health plan provider network. This position
will build and nurture positive relationships with health plan
network participants by providing the on boarding orientation, and
delivering guidance and high-quality service through regular
engagement by phone and through scheduled in-person visits to
targeted provider offices. This position will also coordinate with:
Compliance & Quality staff on the re-credentialing process; with
Provider Contracting staff for contracting issues or concerns; and
will periodically assist the Claims staff with auditing and
troubleshooting of provider data to ensure proper claims
adjudication. The Provider Relations Representative knows and
abides by all organizational and departmental policies, sets
personal standards, and strives for high quality work in completing
assignments, performs job duties in a timely manner, and represents
the organization in a positive manner. EDUCATION/EXPERIENCE A
minimum of five years of related experience in the health care or
managed care field of customer service-related work is required.
Bachelor's degree in business, health care, communications, or
other related area is preferred. Recent experience as a provider
relations representative, member service representative, or
relevant claim experience is highly preferred. LICENSURE Valid
Texas driver's license as well as a reliable vehicle is
required.
Keywords: University Health, San Antonio , Provider Relations Representative, Other , San Antonio, Texas
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