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Provider Rels Representative

Company United Concordia Companies Inc
Location Home, PA
Update 7 Day ago

This position will cover Western PA region or Eastern Ohio region*

General Overview:
The Provider Relations Representative is the primary liaison between the provider network and the Corporation. Maintain a quality network of providers who supply medical and dental care, goods and services to members. Responsible for recruitment, personal visits, orientation and interactive training. Apply an active role in network management, training, monitoring and enforcement of company policies and procedures while increasing provider efficiencies. The lead level will assist the Director with development, administration and communication to include registration of and contracting with providers for the accurate and timely payment of claims to providers and members.

Essential Responsibilities:
1. Conduct on-site visits to provide orientation, continuous training and education to the provider network. Partner with the health care provider network to encourage their support of company initiatives as well as compliance with policies and procedures.

2. Monitor, analyze and develop strategies for improving network participation and performance. Recruit additional providers to enhance the company’s ability to promote a network to current and potential customers. Deliver efficient communications between providers and the corporation, ensuring providers utilize various electronic means of communication.

3. Fulfils a liaison role with Operations and Support areas to ensure the appropriate development and execution of initiatives, communication needs, and issue resolution.

4. Communicates and maintains effective working relationships both internally (team members, management, and other key areas with whom we work closely) and externally (providers, provider associations, vendors) keeping management informed on related healthcare industry issues/topics.

5. May be a team member for corporate projects impacting providers ensuring team and provider communication is appropriate, provider impacts are considered, and appropriate tasks are executed by team members.

6. May provide strategic and operational input for network development and servicing to ensure members have access to quality, cost effective care and that the plan appropriately and timely responds to the customers’ needs and efficient/effective operations of the department are maintained to meet corporate initiatives.

7. Other duties as assigned or requested.

Minimum Qualifications:
HS Diploma or GED

3-5 years of relevant, progressive experience in the area of specialization.

Valid Driver License

Preferred Qualifications

Bachelors’ degree

1-3 years of Project Management and/or Business Analyst experience

3 years of management or leadership experience

Dental Insurance experience preferred

Knowledge, Skills and Abilities

Strong interpersonal organizational and analytical skills and management skills and the ability to perform under pressure within rigid time constraints, without the loss of efficiency, quality and professionalism as demonstrated by previous positions held.

Willingness and agreement to continue educational course work in direct relation to the position and travel for additional training or business purposes as necessary.

Demonstrated ability to analyze situations and data to identify issues, determine points of relevance and proper course of actions.

Superior communication (written and oral), teamwork, organizational and leadership skills as demonstrated through previous performance, testing and/or academic background.

Ability to identify, establish and meet corporate goals and objectives.


Is Travel Required?



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