Provider relations representatives work for healthcare agencies as liaisons with healthcare providers. They are responsible for creating long-term relationships with providers and engaging with them regularly to ensure they are appropriately informed and updated on products, service offerings, and the latest technology available to them.

Provider Relations Representative Job Description Template

We are looking for a provider relations representative to liaise with healthcare providers and clients on healthcare-related issues, of which the majority are related to claims and provider participation. You will also be required to enter claims data for processing.

To ensure success as a provider relations representative, you should be highly organized and have excellent communication skills. Ultimately, a top-notch representative should resolve queries and train healthcare providers to ensure operational efficiency.

Provider Relations Representative Responsibilities:

  • Initiating and maintaining effective channels of communication with service providers and clients.
  • Gathering, reviewing, and verifying all pertinent information relating to participating healthcare providers.
  • Establishing and maintaining relationships with assigned healthcare providers through office visits, telephone calls, prompt resolution of issues, and excellent customer service.
  • Conducting training of service providers on policies, procedures, service lines, and available technology.
  • Answering questions from doctors’ offices on benefits.
  • Gathering, reviewing, and submitting relevant documentation needed for claims processing.
  • Managing healthcare provider accounts to achieve company strategies and goals.
  • Maintaining a working knowledge of all applicable federal, state, and local laws and regulations regarding healthcare.
  • Assisting help desk staff with more complicated benefit queries received.
  • Identifying shortfalls in healthcare provision and initiating improvement opportunities.

Provider Relations Representative Requirements:

  • A bachelor’s degree in healthcare administration or equivalent.
  • A minimum of 2 years’ experience in client services, provider relations, and claims processing.
  • Knowledge and understanding of claims processes and data capturing.
  • Proficiency in creating presentations, training documents, reports, and analytical graphs.
  • Proficiency in MS Outlook, Excel, and Word.
  • Ability to work independently.
  • Excellent verbal and written communication skills.
  • Good problem-solving skills.