Provider Relations Representative Resume Examples

provider relations representative

  • Resolve provider complaints or answer providers’ questions regarding policies and procedures
  • Complete applications for providers for contracting and credentialing
  • Answer questions regarding requirements for completing credentialing application
  • Provide prompt service and guidance on inbound phone line
  • Resolve claim issues
  • Operate phone system for inbound, outbound, parked, transferred and active calls
  • Perform in-depth inquiry into challenges and issues faced by provider offices

senior provider relations representative

  • Collaborates with the PR Director and/or Manager to develop strategies in order to achieve department and company goals. 
  • Train new PR Reps to ensure they have the necessary tools/resources to perform their assignments. 
  • Gathers and prepares written and oral communication for distribution to contracted providers on a monthly/quarterly basis.
  • Record information accurately and communicate in return about what information was given and what was received

provider relations representative

  •  Researched and resolved disputes, billing discrepancies and claims immediately with regard to customer satisfaction. 
  •  Planned, organized and conducted orientations and site visits 
  • Recruited physicians in accordance to network requirement goals
  • Negotiated and renegotiated contracted with physicians/physicians group
  • Assisted in credentialing and re-credentialing process to ensure provider’s applications are correct and expedited. Claim resolution.
  • Built and maintained professional relationships with the providers to ensure provider satisfaction 
  •  Co-chaired HealthPlan Credentialing Committee

senior provider relations representative

  • Led and organized recruitment, operations and the logistics involved in the implementation of CIGNA’s policies and procedures.
  • Reviewed and analyzed facility activities and data to aid planning, risk management and to improve service utilization for.
  • Developed and implemented organizational policies and procedures for the facility and physician offices.
  • Developed instructional materials and conduct in-service and -based educational programs.
  • Conducted large scale hospital seminars for hospital staff members and physician offices.

provider relations representative

  • Implement corporate or departmental policies, procedures, and service standards in conjunction with management
  • Performed NCQA compliant site audits of Primary Care Providers.