Provider Relations Representative

Evaluates assigned territories and negotiates contracts with physicians, specialists, ancillary providers and hospitals.

Essential Functions & Responsibilities

• Target potential providers to establish contractual agreements.
• Analyzes and evaluates assigned territories for recruitment needs,
• Recruits and contracts physicians, specialists, ancillary providers and hospitals for HN1 with inclusion of al necessary documentation, i.e. credentials, site visits.
• Researches and solves any questions or concerns that providers may have.
• Negotiates contracts for HN1 with inclusion of all necessary documentation, i.e. credentials.
• Works with contracted providers to integrate their services into the overall care delivery network.
• Maintain lines of communications with all internal departments and with all participating providers in enlisting their assistance in referring potential providers in the Network.
• Organize reports for presentation to senior management staff.
• Support other departments as needed.
• Expedites and researches provider’s utilization data with reference to negotiating new rates.
• Responsible for conducting site visits of all newly contracted providers.
• Supports Credentialing Department by assisting with the collection of physician credentials for re-credentialing purposes.
• Maintains and updates physician files.
• Evaluates claim data on recently contracted providers, ensuring contract is profitable for Company.
• Respond to provider inquiries regarding contracts, provider networks and HN1 operations.
• Complies with all Company HIPAA polices and procedures.
• Ensures integrity of data entered into company systems and/or databases.
• Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
• Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
• Ability to come to work and work the regular schedule and shift for the position.
• Compliance with all personnel policies and procedures.
• Perform additional duties and related essential duties as assigned.