Provider Relations Representative

Coto Laurel,Puerto Rico

communication Work History Provider Relations Representative , 11/2019 to 03/2020 Physicians Partners Group Puerto Rico – Hato Rey , P , R , Managed provider relations mailbox by triaging inquiries...excellent interpersonal abilities , Skills Provider relationship management Strategic Business Relationships Relationship development Provider orientations Provider support Workflow Analysis Data Analysis

Provider Relations Representative

Integra Partners/DMEnsion Benefit Management LLC Sterling Heights,Michigan

years) , Excel (15 years) , MASYS (13 years) , Sales Force (1 . 5 years) Experience Provider Relations Representative 05/2015 to Current Integra Partners/DMEnsion Benefit Management LLC Responsible for...department with re - credentialing . Locate providers for single case agreements when necessary . Provider Relations Rep 06/2004 to 05/2015 Wright & Filippis Responsible for maintaining network of providers ...on Number . Provider and Member grievances . Maintaining excel spreadsheets for distribution to clients . Maintaining computer system with providers . Worked up mass mailings for Provider Bulletin and

Provider Relations Representative

UNIVERSAL AMERICAN Pasadena,Texas

Triage patients , Pediatric vitals Experience Provider Relations Representative 12/2014 to Current UNIVERSAL AMERICAN Houston , Texas Develop the provider network of my assigned territory , i . e . for...plan and the providers in regards to the provider participation , claim issues , recruitment and terminations . Daily communication and visits to the provider offices , hospitals , skilled nursing ...school . Supervised Student Service Department Staff as well as solicited and maintained service provider relationships . Assisted in the process of the administrative staff and teacher's recruitment Counseled

Provider Relations Representative

Delta Dental of California Fort Lauderdale,Florida

Florida , FL Provider Relations Representative 02/2019 - Current Identifies , recruits and contracts with new providers for dental provider networks . Expands network relations with existing contracted.... Plans organize and conduct educational workshops for provider offices within the designated territory . Represents Delta Dental at provider meetings , community events , and local professional a...acts as a liaison to other departments in resolving escalated claims issues . Prepares individual provider correspondence and follow up in response to customer service , claims or other problems . Stayed

Provider Relations Representative

United Health Group Saint Louis

Experience Provider Relations Representative , 08/2016 to 02/2018 United Health Group Researches and communicates information regarding member eligibility , provider status and authorization inquiries...manner . Work History Provider Relations Representative , 08/2016 to 02/2018 United Health Group Researches and communicates information regarding member eligibility , provider status and authorization...confirm prior authorizations and process them for payment . Exchange/Returns Customer Service Representative , 09/2015 to 06/2016 IKEA – St . Louis Work closely with Customer Service Department for Complaint

Sr. Provider Relations Representative

SelectHealth Boise

building Problem resolution ability Healthcare billing proficiency Experience Sr . Provider Relations Representative Mar 2014 to Current Select Health － Meridian , ID Work with regional hospital admi...in home infusion , revenue cycle management , insurance claims , contract management , provider relations , and medical office environments . Skills     Intravenous therapy and specialty pharmacy...negotiate provider contracts with insurance companies to ensure fair pricing for services . Update and submit provider credentialing applications to insurance companies and preferred provider organizations

Provider Relations Representative

Physicians Partners Group Puerto Rico Coto Laurel,Puerto Rico

prospecting Work History Provider Relations Representative , 11/2019 to 03/2020 Physicians Partners Group Puerto Rico – Ponce De Leon Avenue , Hato Rey , P . R . Managed provider relations mailbox by triaging...Professional Summary Seasoned Provider Relations Representative possessing in - depth knowledge of various insurance plans and policies . Expertise in handling high volume of calls , efficiently resolving...abilities . Skills Provider relationship management Service optimization Strategic Business Relationships Educational Presentations Relationship development Provider orientations Provider support Workflow

Provider Relations Representative

Missouri Care Health Plan, a WellCare Health Plan Saint Joseph,Missouri

Experience Missouri Care Health Plan , a Well Care Health Plan May 2013 to Current Provider Relations Representative Columbia , MO - work from home Create and manage cooperative relationship with providers...Columbia , MO - work from home Managed provider network in 13 counties . Negotiated Primary Care , Specialty and Ancillary provider contracts . Completed new provider orientations . Compiled and submitted...of Medicaid contractual requirements , billing and member benefits . Conduct ongoing analysis of provider network to ensure adequacy . Provide issue resolution and complex trouble shooting for claims payment

Credentialing Manager

Royal Health Care Centereach,New York

management meetings , finance meetings and board meetings .  •Work closely with the Provider Relations Representative to coordinate services .  •Ensure that contractual obligations are completed timely... .  •Coordinate the production of special reports as requested by the Plan .   Provider Relations Representative March 2004 to December 2008 Royal Health care － Islandia , NY •Orient new providers... of all provider contacts .  •Conduct provider surveys ; assist with Quality Assurance studies .  •Act as an internal and external resource regarding provider development and relations .  •Conduct

Field Operation Advisor

Crystal Lake,Illinois

workflows and collaborate with leadership towards improvements and standardizations , Provider Relations Representative , 01/2010 , 01/2014 Advocate Physician Partners , Rolling Meadows ...leading partnership meetings and identifying on , site training opportunities , Managed provider relations mailbox by triaging inquiries , facilitating resolution , and forwarding requests...maintain customer satisfaction with Physicians partners , Developed , reviewed and prepared provider educational material to increase performance outcomes , Collaborated with physician members