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Provider Relations Representative - Remote / Telecommute
Provider Relations Representative - Remote / TelecommuteCynet Systems • Baltimore, MD
Provider Relations Representative - Remote / Telecommute

Provider Relations Representative - Remote / Telecommute

Cynet Systems • Baltimore, MD
[job_card.30_days_ago]
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  • [job_card.full_time]
  • [filters.remote]
[job_card.job_description]

Job Description:

Pay Range: $24.88hr - $32.88hr
  • The Provider Relations Representative will be responsible for supporting providers through education, relationship management, and issue resolution to ensure quality service delivery and positive member interactions.
  • This role partners with the Provider Training and Education Department, provides analytical support, and acts as a liaison between providers and internal departments to ensure smooth operational and contractual alignment.
Responsibilities:
  • Partner with the Provider Training and Education Department to educate providers on programs, processes, and electronic tools.
  • Provide targeted training to help providers successfully navigate the provider portal and follow company procedures.
  • Support one or more health systems representing multiple practices to ensure Tier One Service delivery.
  • Provide research, analytical, and resolution support for special projects and complex cases.
  • Respond verbally or in writing to inquiries from management, internal teams, and external customers.
  • Assist providers in resolving escalated service-related issues and inquiries through face-to-face visits, correspondence, email, and phone.
  • Build and maintain strong relationships with providers through regular communication and timely problem resolution.
  • Proactively identify provider needs and address them through problem solving and collaboration with internal and external resources.
  • Leverage provider relationships to drive and influence provider behavior towards favorable outcomes.
Requirement/Must Have:
  • High school diploma or equivalent.
  • Minimum of 4 years of experience in the healthcare industry, including experience with providers, training, claims, customer service, and presentations.
Experience:
  • Experience working with providers in a managed care or insurance environment.
  • Experience in training and educating provider networks.
  • Experience handling provider issues and resolving escalations.
Should Have:
  • Bachelor’s degree in Business, Healthcare Administration, or a related field preferred.
  • Previous experience with a Client Client plan, insurance organization, hospital, or physician hospital organization (PHO).
Skills:
  • Proficient knowledge of provider billing and coding mechanisms.
  • Strong understanding of managed care industry regulations and third-party payment methodologies.
  • Ability to interpret and communicate contractual documents effectively.
  • Proficiency in Microsoft Excel, Access, PowerPoint, and Word.
  • Excellent communication and relationship management skills.
  • Strong analytical and problem-solving abilities.
Qualification And Education:
  • High school diploma required.
  • Bachelor’s degree in Business, Healthcare Administration, or related field preferred.

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Provider Relations Representative - Remote / Telecommute • Baltimore, MD

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