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.

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Required Education and Experience

  • Associate's degree (A. A.) or equivalent from two-year college or technical school; and two to three years experience in physician's office, HMO's or other Health Care institutions.

Qualifications

  • Must be able to travel within their territories 80% of the time.
  • Candidate must reside in metro Atlanta area.

Technical Skills

  • Determining the kind of tools and equipment needed to do a job.
  • Ability to use Microsoft Word, Excel, PPT, and other business tools.

Other Skills and Abilities

  • Bilingual is preferred but not mandatory.
  • Knowledge of physician office procedures.
  • Knowledge of medical terminology, CPT coding, billing procedures.
  • Strong Organizational skills.

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