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.