A provider relations representative is responsible for building professional relationships with co-workers and physicians. This job requires one to visit with physicians on a regular basis and help them improve their business; this can range anywhere from sitting with him/her to discuss quarterly statistics to giving lectures to physicians in small groups. Those who are ideal for this position are extremely motivated and enthusiastic, and wake up every morning excited to go to work.
A provider relations representative must be well-educated and have a very strong social network. Qualifications generally include a Bachelor’s degree in Health Care or a similar field. Those in this position should also have excellent communication and decision-making skills. Social networking is a huge part of becoming a provider relations representative; in order to make a business grow and succeed, one must be willing to share ideas with others. This job also requires a vast knowledge of computers, specifically Microsoft Word and Microsoft Excel. Knowing how to enter dates into Excel and crunch numbers is an absolute must for the position.
Knowledge of other computer programs is a bonus, but not required. Furthermore, this position requires quite a bit of traveling, so a stable means of transportation is required. Lastly, provider relations representatives must be able to multitask and have multiple assignments completed quickly. They often have their hands full with work, but are always able to finish it on-time.
Provider Relations Representative Tasks
Build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers.
May also be involved in identifying and remediating claims.
Assist with the full range of provider relations and service interactions, including working on end-to-end provider claim and call quality and training and development of external provider education programs.