Provider Representative Resume Samples
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Provider Representative Resume Samples
The Guide To Resume Tailoring
Guide the recruiter to the conclusion that you are the best candidate for the provider representative job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.
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GJ
G Jones
Golden
Jones
811 Jones Avenue
Philadelphia
PA
+1 (555) 639 0074
811 Jones Avenue
Philadelphia
PA
Phone
p
+1 (555) 639 0074
Experience
Experience
Los Angeles, CA
Provider Engagement Representative
Los Angeles, CA
Koelpin, Koepp and Huels
Los Angeles, CA
Provider Engagement Representative
- Educate providers by instructing and advising of the comprehensive policies and procedures involving all phases of the corporation’s benefits and contracts through office visits and communication over the phone and email
- Develop and continually improve personalized presentations of company benefit programs
- Recruit non participating providers to join our networks
- Assist provider offices in filing their claims electronically
- Organize and present information to providers and their staff by speaking before various provider organizations and representing the corporation in dental related activities
- Develop and implement approaches by working with dentists and their office staff to improve the quality of information exchanged between the company and dental offices
- Assist in resolving elevated complaints and issues for clients, members and providers
Los Angeles, CA
Provider Enrollment Representative
Los Angeles, CA
Becker Inc
Los Angeles, CA
Provider Enrollment Representative
- Data entry of provider information within the provider enrollment applications and other supporting documents into the Medicaid Provider System
- Provide feedback to reduce errors and improve processes
- Interfacing with providers to answer inquiries or gather further information regarding a provider’s enrollment via telephone and written correspondence
- Prepare documents necessary for issuance of provider numbers for physicians, physician assistants, and nurse practitioners
- Follow-up with provider for missing billing paperwork and document the system
- Provide functional support to the Provider Enrollment Support Team within the Operations Support Department
- Assists with preparing application packets for mailing to the providers and carriers
present
San Francisco, CA
Provider Contracting Representative
San Francisco, CA
Pfannerstill Group
present
San Francisco, CA
Provider Contracting Representative
present
- Working knowledge in the areas of Group Practice Management, Specialists and Ancillary providers
- Prior demonstrated success in provider contracting with both large physician groups and ancillary providers
- 5 years in managed care contracting or provider relations
- Working knowledge of Microsoft Office applications to include Word, PowerPoint and Excel
- Proficiency in MS Excel (sort, filter, manipulate data) and PowerPoint (create presentations)
- Proficiency in MS Excel (sort, filter, manipulate data) and PowePoint (create presentations)
- Knowledge of Long Term Care Manage Care Plan
Education
Education
Associate’s Degree in Business
Associate’s Degree in Business
University of Tennessee
Associate’s Degree in Business
Skills
Skills
- Attention to detail and quality-oriented
- Ability to communicate clearly and professionally with client and management
- Great organizational skills and time management skills
- Excellent verbal and written communication skills. (Examples include: ability to write clear and concise billing instructions to providers, interpret effects of change orders on systematic claim processing process.)
- Ability to multi-task
- Previous team leadership is requested
- Previous experience creating and delivering formal presentations
15 Provider Representative resume templates
Read our complete resume writing guides
1
Provider Contracting Representative Resume Examples & Samples
- Negotiate and re-negotiate high-volume, transactional-style provider contracts
- Function as the point-of-contact for all on-going contractual and service issues as needed by providers
- Facilitate provider education, training them in order to increase their familiarity and satisfaction with Humana’s systems and strategies
- Create trend analyses and summaries for decision-making purposes
- Interface with market leaders to align contracting needs and business efforts
- Independently works to coordinate with other MSO departments for training and development of providers
- Prior health solutions system experience in the areas of contracting or operations
- Ability to travel to local provider offices approximately 3 to 4 days weekly
- Medicare product knowledge
- Valid FL driver's license
- Demonstrated strength in communication skills
- Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and Access
- Previous training/education experience
- Previous experience as a practice manager or high level medical office manager
2
Provider Contracting Representative Resume Examples & Samples
- Negotiate and re-negotiate high-volume, transactional-style physician contracts
- Function as the single point-of-contact for all on-going contractual and service issues as needed by providers
- Experience presenting to varied audiences
- Ability to manage multiple priorities in a fast-paced environment
- Knowledge of Microsoft Office applications
- Driver’s license and vehicle are required
- Bachelor’s Degree in Business, Finance or a related field; or a minimum of 2 years’ relevant business experience
- Experience in managed care contracting and/or provider relations
3
Provider Contracting Representative Resume Examples & Samples
- Negotiate and re-negotiate high-volume, transactional-style physician and Ancillary contracts
- Primarily based in Orlando or Tampa market offices however responsible for managing providers in multiple markets
- Travel, as required
- Bachelor’s Degree in Business, Finance or a related field; or a minimum of 3 years’ healthcare business experience
- Be a self-starter, ability to work independently and handle ambiguity
- Strategic, analytical, process oriented and must have critical thinking skills
- Ability to manage multiple priorities and adapt to change in a fast-paced environment
- Working knowledge of Microsoft Office – Word, Excel, PowerPoint & Outlook
- Driver’s license and vehicle are required and ability to travel 30% in the central Florida area
- Experience with Medicare
- Experience in managed care contracting
- Experience with provider relations
- Bilingual in Spanish
4
Provider Contracting Representative Resume Examples & Samples
- High school diploma or equivalent required
- Knowledge of Microsoft Office Excel & Word applications
- 75% travel covering Central Florida (Orange, Osceola, Seminole, Sumter, Marion, and Lake counties), valid driver’s license and vehicle are required
- Master’s Degree in Business Administration or a related field
5
Provider Contracting Representative Resume Examples & Samples
- Demonstrated communication and facilitation skills
- Ability to travel to local provider offices
- Bachelor’s Degree in Business, Finance or a related field
6
Provider Contracting Representative Resume Examples & Samples
- Auditing and analysis of provider contracts
- Prior health solutions system experience
- Minimum of a Bachelor’s degree
- Prior experience in an administrative support role
- Intermediate knowledge of Microsoft Office applications, Word, Excel and Access
- Ability to travel up to 50% in the Tri County area from Palm Beach to Miami-Dade
- Prior physician contracting experience
- Strong analytical skill set
- Prior strategic experience
7
Provider Contracting Representative Orlando Resume Examples & Samples
- Negotiate and re-negotiate Physician Contracts
- Function as the point-of-contact for all on-going contractual initiatives and service issues as needed by Contracted Providers
- Facilitate Provider education, training in order to increase their familiarity and satisfaction with CarePlus Health Plans’ systems, initiatives, processes and strategies
- Create analyses and summaries for identified network gaps and deficiencies
- Set targets and priorities in order to meet national and market-specific network needs
- Must have high school diploma or equivalent
- Minimum of 2 years of experience in managed care contracting and/or provider relations
- Proficiency in analyzing, understanding and communicating financial trends
- Intermediate in MS Word and Excel
- Overall knowledge of Medicare standards and regulations
- Interpersonal and communications skills
- Customer Service skills
- Manage multiple projects and priorities
- Valid State of Florida Driver’s license
- Ability to travel up to 50% locally
- Bilingual (English and Spanish), preferred; must be able to read, write and speak English
- Bachelor’s Degree (BA/BS)
8
Provider Enrollment Representative Resume Examples & Samples
- Complete and submit applications for enrollment with Medical, Medicaid, and various other
- Commercial Plans
- Mailing of applications via USPS and/or email
- Data entry and maintenance into database in accordance with internal policies and procedures
- Maintain assigned market/region in all aspects of payor enrollment/external credentialing
- Apply knowledge/skills to complex activities
- Provide feedback to reduce errors and improve processes
- Develop and maintain relationships with market leadership
- Anticipate customer needs and proactively identify solutions
- Independently and as a team solve complex problems
- Prioritize work tasks
- Participate in audits
- Act as technical resource to others in own function
- Provide utmost customer service
- Adapt well in a changing environment
- HS Diploma/GED
- Experience with ALL of the following: PECOS, NCQA Standards related to Credentialing, CMS Regulations related to credentialing, and conducting web-based research
- 3+ years of experience enrolling providers into Medicaid, Medicare, and Commercial Health Plans (Payor Enrollment)
- Must be able to: Excel – sort, filter, data entry, export and import data, Word – create and modify documents, and Outlook – manage emails and calendars
- CPCS Certification
- Experience with ANY of the following: MS Access, Adobe Acrobat Pro, Crystal Reports
9
Provider Reimbursement Representative Resume Examples & Samples
- Comprehends Provider contracts, is able to determine capitation terms and effectively incorporate changes and / or updates for configuration. Appropriately tests all changes for accuracy and implements into the cap process
- Identify and configure necessary additions, changes and deletions to new and existing configuration design as it relates to capitation
- Originates scheduling of pre cap/post cap calculations and capitation reports. Coordinates report extractions with Business Analyst and team members. Identifies variances and issues, analyzes and implements data for review, communicates issues and receives approvals from Executive Directors
- Ensures accuracy of data on Excel spreadsheets by verifying proper linking. Audits raw data, compares with worksheets to verify proper PCP/Specialty cap calculations. Generates and submits PCP/Specialty cap payment upload requests to Accounts Payable for processing
- Works with Lead, Business Analysts and Manager, in troubleshooting system and reporting or process issues. Must be able to effectively analyze issues and communicate problem-solving ideas
- Reconciles PCP/Specialty cap expense to general ledger. Generates cap related reports to perform PCP/Specialty audits, adjustments, check requests, analyses, research and special projects, as required
- Collaborates with the IS staff in developing and testing of System upgrades
- Utilizes various computer programs to research provider, member and eligibility information. (Claims System/Claims System test, Crystal, Excel, Word, Access, Great Plains)
- 3+ years of demonstrated success in analysis and problem solving in finance-related positions with increasing levels of responsibility
- General knowledge in managed care industry and insurance billing / collections
- Must be able to effectively communicate both verbally and in writing with all levels of management and to prioritize goals and responsibilities in a proactive manner
- Self-motivated with excellent organization, analytical and follow-up skills, accuracy, flexibility and attention to detail
- Working knowledge of Excel, Word, Outlook
- Ability to work independently and to participate as a team member
- Capability to pool resources and set and obtain goals in a team environment while demonstrating good judgment, attitude and professionalism
- Microsoft Access experience
- 2+ years of college with an emphasis in business, finance or accounting
- Understanding of transaction systems and data flow
- A basic knowledge of ICD 10 and CPT coding
10
SCA Provider Enroll Representative Resume Examples & Samples
- H.S. diploma; or any combination of education and experience, which would provide an equivalent background
- 1-3 years’ experience in Provider Enrollment, Provider Relations, or Credentialing preferred
- Proficient computer skills in Microsoft Word, Excel and databases
- Capable of meeting time-sensitive deadlines and multi-tasking
11
Provider Contracting Representative Resume Examples & Samples
- Negotiate and re-negotiate high-volume, transactional-style physician and ancillary contracts
- Minimum of 2 years relevant provider contracting experience
- Prior demonstrated success in provider contracting with both large physician groups and ancillary providers
- Experience presenting to varied audiences Ability to manage multiple priorities in a fast-paced environment
- Bachelor's Degree Business Administration
- Experience with ACO/Risk Contracting
- Working knowledge in the areas of Group Practice Management, Long-Term Acute Care, home health, home infusion, behavioral health, ambulatory surgery, and the outpatient experience
12
Provider Contracting Representative Resume Examples & Samples
- Facilitate provider education, training them in order to increase their familiarity and satisfaction with Humana systems and strategies
- Experience in managed care contracting or provider relations
- 50% travel primarily covering Broward county, valid driver’s license and vehicle are required
- 5 years in managed care contracting or provider relations
13
Senior Provider Reimbursement Representative Resume Examples & Samples
- 1+ year of NDB, ppoONE, iCES and UHC claim pricing knowledge
- 1+ year of experience analyzing and handling escalated issues for UHC priced claims while being a liaison for UMR
- 2+ years of experience with CPS claim processes
- Knowledge of UHC provider contracts
14
Provider Enrollment Representative Resume Examples & Samples
- Data entry of provider information within the provider enrollment applications and other supporting documents into the Medicaid Provider System
- Reviewing provider enrollment applications and other documents for completeness
- Verifying entries made into the Medicaid Management Information Systems (MMIS) and other computer applications as needed
- Maintaining and updating the records of providers following the policies and procedures of NYS
- Interfacing with providers to answer inquiries or gather further information regarding a provider’s enrollment via telephone and written correspondence
- Ensuring the accurate and timely enrollment and maintenance of all Medicaid Provider Enrollment functions
- Meets performance standards for accuracy, timeliness, and confidentiality
- Acts as a liaison to providers enrolling in the Medicaid program
- Acts courteously and effectively with all stakeholders within the community
- Other duties as assigned by Management
- Two years of healthcare experience
- Ability to follow stringent instructions
15
Provider Data Attestation Representative Resume Examples & Samples
- Investigate non-standard requests and problems, with some assistance from others
- Work exclusively within a specific knowledge area
- Prioritize and organize own work to meet deadlines
- Provide explanations and information to others on topics within area of expertise
- Ability to travel up to 25% within the region you support
- Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area
- 2+ years of healthcare industry experience including customer service or provider relations experience
- Intermediate level of proficiency with MS Word and Excel
- Basic level of proficiency with PowerPoint
- Experience with MS Access
- Intermediate level of proficiency in claims processing and issue resolution
- Exceptional presentation, written and verbal communication skills
- Ability to work independently and remain on task
- Good organization and planning skills
- Ability to prioritize and meet deadlines from multi - staff members within the department
16
Provider Reimbursement Representative Resume Examples & Samples
- Applies knowledge/skills to activities that often vary from day to day
- Demonstrates a moderate level of knowledge and skills in own function
- Requires little assistance with standard and non-standard requests
- Works with supervisor to solve more complex problems
- Prioritizes and organizes own work to meet agreed upon deadlines
- Works with others as part of a team
- Previous UHN plan experience
- Strong research and analytical skills
- Excellent interpersonal skills at both an individual and team level
17
Provider Data Entry Representative Resume Examples & Samples
- Respond to routine or standard requests
- Experience with MS Excel required
- Experience working in production based environment required
- 1+ years of work experience in a healthcare setting
- 2+ years of data entry experience
- 1+ years of experience production environment meeting production and quality goals
- Proficiency in Microsoft Office Suite (ability to create and edit documents in Word; ability to sort, filter, create tables and search data in Excel)
- Experience working in Provider Relations, Medical Billing or Quality Management experience
- Experience working with healthcare providers
- Experience in medical claims processing
- Strong interpersonal and oral communication skills including telephone etiquette
- Strong organizational skills, ability to prioritize and meet deadlines
18
Provider Contracting Representative Resume Examples & Samples
- Evaluates member service needs reports to ensure that there are sufficient providers contracted to meet member care needs
- Negotiates and maintains contractual relationships with vendors in areas of service needs
- Updates and maintains network tracking systems on the current status of pending and renewing vendor applications
- Serves as an educator/liaison with providers to ensure providers are current on Statewide Medicaid Managed Care (SMMC) programs, policies & procedures, billing practices, accessibility standards and contracted service requirements
- Responds to corporate office requests to obtain updated status on pending contracts and outstanding documentation and/or compliance issues
- Attends trade organization events, conferences and business networking meetings on a regular basis
- Consistently meets established productivity
- One to three years related experience
- Knowledge of Microsoft Office programs
- Must possess strong communication skills, both verbal and written
- This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
- This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits
- Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work
- Must have accessibility to high speed DSL or Cable modem for a home office (No Satellite)
- AHCA Fingerprint Required
- Associates or a Bachelors Degree
- Three years healthcare industry experience working in Provider Relations
- Knowledge of Long Term Care Manage Care Plan
19
Provider Enrollment Representative Resume Examples & Samples
- Generate, complete, and submit applications for new and established enrollments with Medicare, Medicaid, and
- Various other Commercial Plans
- Meticulously review documents prior to transmission of applications via UPS and/or email to providers and
- Health plans
- Data entry and maintenance into Vistar (eVIP) database in accordance with internal policies and procedures with
- High‐level accuracy
- Maintain assigned market/region in all aspects of provider enrollment
- Prioritize work tasks independently
- Participate with internal and external audits
- Provide exceptional customer service to our internal and external contacts
- Experience with PECOS, CMS Regulations related to enrollment, and conducting web‐based research
- Proficiency within Microsoft Excel – sort, filter, import / export data, basic formulas
- Proficiency within Microsoft Outlook – manage emails and calendars
- Proficiency within Microsoft Access – pull reports (already created), search and modify records
- Proficiency within Adobe Acrobat Pro – merge files and edit content
- Proficiency within eVIP Database
20
Representative, Provider Services Resume Examples & Samples
- Handles heavy inbound call volume/correspondence with knowledge to address more complex concerns from Provider Community
- Interacts with providers, in a timely and professional manner, including escalating recurring or critical issues to appropriate Team Lead or Manager
- Navigates through the system with efficiency
- Assists team members with questions and supports less experienced staff as needed
- Meets and retains all quality and production standards set by management and/or customer
- Handles special projects that include but are not limited to assisting with more difficult programs, complex inquiries and issues, and required research, and state mail in timely manner
- 3-5 years Customer Service/Call Center experience in medical claims
21
Representative, Provider Services Resume Examples & Samples
- Under general supervision/direction, responsible for supporting various provider services functions with an emphasis on working externally with the Plan's providers to educate, advocate and engage as valuable partners
- Requires provider services and contracting subject matter expertise
- 5 years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, group and hospital contracting, etc
22
Provider Contracting Representative Resume Examples & Samples
- Interface with market leaders and other internal departments to align contracting needs and business efforts
- Primarily based in Miami market offices however responsible for managing providers in multiple markets
- Minimum of 5 years’ provider contracting or provider relations experience
- Advanced knowledge of Excel
- Intermediate with Microsoft Word, PowerPoint & Outlook
- Driver’s license and vehicle are required and ability to travel up to 10% in the Miami area and within the state of Florida at times
- Experience in capitation contracting
23
Provider Enrollment Representative Resume Examples & Samples
- Generate, complete, and submit applications for new and established enrollments with Medicare, Medicaid, and various other Commercial Plans
- Meticulously review documents prior to transmission of applications via UPS and/or email to providers and health plans
- Data entry and maintenance into Vistar (eVIP) database in accordance with internal policies and procedures with high‐level accuracy
- 2+ years of Provider Enrollment Processes experience
- Proficiency within Microsoft Word (ability to create and modify documents)
- Proficiency within Microsoft Excel (sort, filter, import / export data, basic formulas)
- Proficiency within Microsoft Outlook (manage emails and calendars)
- Proficiency within Microsoft Access (pull reports (already created), search and modify records)
- Proficiency within Adobe Acrobat Pro (merge files and edit content)
24
Provider Data Attestation Representative Resume Examples & Samples
- Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area (including valid Driver's License and Insurance)
- Customer service or provider relations experience
- Intermediate level of proficiency with Microsoft Word (edit and create documents) and Microsoft Excel (manipulate data, run reports, filter, data entry)
- Basic level of proficiency with Microsoft PowerPoint (ability to navigate and present to providers - will not be creating presentations)
- Experience with Microsoft Access (for transferring data from Microsoft Excel)
25
Provider Performance Representative Resume Examples & Samples
- Microsoft Windows applications
- Knowledge of Medicaid and Medicare programs preferred
- Knowledge of Commercial health plan programs desirable
- Ability to plan and organize
- Strong customer service skills and techniques
- Ability to negotiate and implement contracts
26
Provider Enrollment Representative Resume Examples & Samples
- High School Diploma / GED or higher
- 1+ year of Data Entry experience
- Vistar database experience
27
Provider Representative Resume Examples & Samples
- Travel the western half of the state bi-weekly to visit Healthcare Providers regarding the program
- Build contacts, relationships, and trust with providers in your area
- Conduct training for provider offices in a large group setting
- Communicate through clear, concise and well-constructed written correspondence and verbal communication
- Conduct research regarding the initiative reports that are delivered to providers quarterly
- Exercise a great depth of knowledge of the episodes of care to answer questions, conduct research, and perform requested duties
- Have the ability to multi-task, self-manage, and prioritize tasks based on importance
- Execute exceptional critical thinking and analytical skills as well as effective time management to ensure work is completed efficiently and accurately
- All other tasks as assigned by leadership
- Requires a Bachelor’s degree and, at a minimum, 1-3 years of Medicaid or other Healthcare claims processing experience
- Previous team leadership is requested
- Great organizational skills and time management skills
- Excellent verbal and written communication skills. (Examples include: ability to write clear and concise billing instructions to providers, interpret effects of change orders on systematic claim processing process.)
28
Provider Contracting Representative Resume Examples & Samples
- Minimum of 2 years of experience working in provider contracting and/or provider relations
- Proficiency in MS Excel (sort, filter, manipulate data) and PowePoint (create presentations)
- Experience with Risk Contracting
- Working knowledge in the areas of Group Practice Management, Specialists and Ancillary providers
29
Provider Installation Representative Resume Examples & Samples
- Provider Data Entry
- Data maintenance and verification
- Initiating database improvements
- Data integrity and quality assurance
- 1+ years of Data Entry experience
- Proficiency with Microsoft Excel (filter, sort, create, and edit spreadsheets)
- Ability to type at least 50 WPM
- Ability to work 6:30 am to 5:00 pm (can choose to start between 6:30 am and 8:30 am and work an 8 hour shift) and occasional mandatory overtime based on business needs
- Previous experience in Medical Claims Processing
- Previous experience in the Healthcare Industry
- Intermediate proficiency with Microsoft Word and Microsoft Excel
- Experience multi-tasking and applying attention to detail
30
Provider Contracting Representative Resume Examples & Samples
- Bachelor’s Degree in Business, Finance or a related field or a minimum of 2 years’ relevant provider contracting experience
- Previous experience in provider relations
- Working knowledge of Microsoft Office applications to include Word, PowerPoint and Excel
31
Provider Enrollment Representative Resume Examples & Samples
- Provide functional support to the Provider Enrollment Support Team within the Operations Support Department
- Prioritize tasks and facilitate operations support activities based on TIN management needs, regulatory changes, and/or mergers and acquisitions
- Completes physician, nurse practitioner, and physician assistant applications to enroll/dis-enroll providers with payers and to modify provider data with payers
- Update TeamWorks provider database as needed
- Follow TeamHealth policies, procedures, and protocols in order to ensure accuracy, completeness, and efficiency of provider enrollment processes
- Perform other duties as assigned (this may include tasks in regional service centers)
32
Representative, Provider Services Resume Examples & Samples
- Under minimal direction, works directly with the Plan's external providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service
- Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's)
- Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include: administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.)
33
Provider Services Representative Field Resume Examples & Samples
- Supports New Market network development and management
- Provides PCRP & CSST ticket resolution and National Contract Management support services
- 5 years provider contract negotiations
34
Provider Engagement Representative Resume Examples & Samples
- Maintain network participation by providing support to dentists and dental office managers to improve their understanding of all available benefit programs
- Educate providers by instructing and advising of the comprehensive policies and procedures involving all phases of the corporation’s benefits and contracts through office visits and communication over the phone and email
- Promote dentist adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims
- Recruit non participating providers to join our networks
- Negotiate special deals to maintain compliance and increase access in weak networks
- Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process
- Facilitate Oral Health presentations to various educational institutions and organizations
- Assist provider offices in filing their claims electronically
- Serve as a liaison with dental offices by answering remittance, payment, benefit, claims, and eligibility questions when necessary
- Follow up with all termination letters submitted
- Represent clients and company at health fairs, audits, dental summits, etc throughout your designated market
- Maintain and submit all required reports
- Assist in resolving elevated complaints and issues for clients, members and providers
- Obtain letters of recommendation from providers
- Develop complete understanding of the Office Reference Manuals
- Develop and continually improve personalized presentations of company benefit programs
- Recruit participating and non-participating providers to higher levels of participation
- Provide recommended solutions to market related issues
- Organize and present information to providers and their staff by speaking before various provider organizations and representing the corporation in dental related activities
- Assist in problem resolution by identifying improvement opportunities, evaluating feasibility of programs and presenting recommendations when appropriate
- Develop and implement approaches by working with dentists and their office staff to improve the quality of information exchanged between the company and dental offices
- Resolve difficult claims issues in a timely manner by working with the appropriate internal resources to research and resolve such issues
- Increase access for members by strengthening and expanding existing network
- Help to maintain a secondary network
- Bachelors Degree or relevant experience
- Proven problem-solving skills
- Own transportation for office and site visits (10% - 50% travel required). Valid driver’s license required
- Problem solving and training experience
- Ability to make good judgment conclusions based on data available with minimal supervision
- Dental knowledge with five (5) or more years of office experience
- Managed Care experience
35
Provider Installation Representative Resume Examples & Samples
- Provider data entry
- Conduct audits and provide feedback to reduce errors and improve processes and performance
- Maintain current provider data to ensure the quality of the network
- May be responsible for representing the provider network area on company IT projects
- May assist with reporting and tracking provider calls and complaints
- May participate in the support, coordination, and production of the paper directory cycles
- High School Diploma / GED
- 1+ year of experience in a related environment (i.e. office, administrative or clerical)
- Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
- Ability to work regularly scheduled shifts within our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time as needed
36
Provider Enrollment Representative Resume Examples & Samples
- Assists with preparing application packets for mailing to the providers and carriers
- Prepare documents necessary for issuance of provider numbers for physicians, physician assistants, and nurse practitioners
- Assists Provider Enrollment Specialist and Sr. Provider Enrollment Specialist with preparing necessary documents for issuance of provider numbers for Physicians and Advanced Practice Clinicians(APC)
- Assists Provider Enrollment Specialist, Sr. Provider Enrollment Specialist, and Manager in a team effort on projects, such as new start-ups, change in business (i.e. Tax ID # and entities) as required by carrier, or when directed by the Manager
- Assists the Provider Enrollment Assistant when needed with incoming mail from the Post Office and other TeamHealth locations
- Assists with organizing group and individual provider files
- Assists with preparing and updating applications for issuance of provider numbers for physicians and midlevel aka APC’s providers, makes copies, and faxes information as assigned
- Prepares W-9 forms and correspondence when needed
- Assists Manager with reports
- Communicates information input into the IDX System and TeamWorks including new providers and updates of provider information using the appropriate forms
- Assists with submitting annual forms to the carriers or updated license to the carriers
- Follow-up with provider for missing billing paperwork and document the system
- Assists with CAQH re-attestation or revalidation applications
- Follows TeamHealth guidelines for preparing documents in a consistent and accurate manner
- Reports any detected problems, errors, and/or changes in provider enrollment requirements when discovered
- Understands and complies with TeamHealth Compliance Program
- Receives, logs, and distributes all incoming work to the appropriate Sr. Provider Enrollment Specialist
- Answers telephone, direct calls, and distribute messages
- Meticulous accuracy
- Effective oral and written communication skills
- Minimum of 45-50 WPM typing skills
- Computer literate
- Good decision-making and problem-solving skills
- Minimum high school diploma or equivalent
- One year of experience in a business setting with fundamental clerical skills, preferably with medical or provider enrollment background
- Preferred experience with health care billing and medical reimbursement
37
Provider Reimbursement Representative Resume Examples & Samples
- Originates scheduling of pre-cap/ post-cap calculations and capitation reports. Coordinates report extractions with Business Analyst and team members. Identifies variances and issues, analyzes and implements data for review, communicates issues and receives approvals from Executive Directors
- Ensures accuracy of data on Excel spreadsheets by verifying proper linking. Audits raw data, compares with worksheets to verify proper PCP / Specialty cap calculations. Generates and submits PCP / Specialty cap payment upload requests to Accounts Payable for processing
- Reconciles PCP / Specialty cap expense to general ledger. Generates cap related reports to perform PCP / Specialty audits, adjustments, check requests, analyses, research and special projects, as required
- Collaborates with the IS staff in developing and testing of system upgrades
- Utilizes various computer programs to research provider, member and eligibility information. (Claims System / Claims System test, Crystal, Excel, Word, Access, Great Plains)
- Working knowledge of Microsoft Excel, Microsoft Word, and Microsoft Outlook
- 2+ years of college with an emphasis in Business, Finance or Accounting
- A basic knowledge of ICD-10 and CPT coding
38
Provider Reimbursement Representative Resume Examples & Samples
- Sometimes act as a technical resource to others in own function
- Solve moderately complex problems on own
- Work with team to solve complex problems
- Positions in this function must be knowledgeable and proficient using NDB and ppoONE for repricing UHC claims
- The ability to analyze and consider solutions to resolve UHC claim issues or apply proper UHC pricing methodology
- Must be able to function in a fast-paced environment collaborating with UHC CPO and UMR claim/support areas to bring resolution to UHC Claim Issues
- Assist with UHC provider correspondence, phone calls, projects, and other tasks related to UHC provider relations, as necessary and/or requested
- Must possess excellent time management and organizational skills
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Provider Installation Representative Resume Examples & Samples
- Maintenance of all provider records within the health plan system(s). Includes setup of demographic and specialty information, panel information (if applicable), line of business and fee schedule as instructed
- Assists in ensuring that Provider Directories and regulatory requirements are accurate and that errors are root caused and discussed at the global level to ensure appropriate corrections and improvements are made
- Requests for new or updates to provider records must completed within business mandated service level agreements
- Other assignments and projects as requested
- Strong knowledge of standard PC packages (Microsoft Word, Microsoft Excel, and Microsoft Outlook)
- Ability to work between 6:30 am - 5:00 pm
- 1+ years of previous experience in a healthcare setting particularly with managed care systems
- Knowledge of Medicaid / Medicare / Commercial rules and regulations
- Previous experience working in a production and quality environment
- Ability to utilize complex database systems and claims platforms simultaneously including, but not limited to OHBS and CSP Facets, COSMOS, and NDB
- Strong research, follow-up, documentation, and issue resolution skills
- Strong root cause analysis skills including the ability to take complex matters and format simplified key concepts to provide clear guidance to internal customers
- Ability to work independently and as a team player
- Solid analytical and problem-solving skills using reasoning and available resources to resolve issues
- Independently prioritize and organize own work to complete daily tasks within required business mandated time-frames
- Ability to think independently and is not afraid to ask questions with the goal of continuous improvement in mind
- Ability to effectively adapt and adjust to changing business needs
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Provider Installation Representative Resume Examples & Samples
- Strong knowledge of standard PC packages (Microsoft Word, Excel and Outlook)
- Ability to type at least 50+ WPM
- Strong research, follow - up, documentation, and issue resolution skills
- Experience multi - tasking and applying attention to detail
- Solid analytical and problem - solving skills using reasoning and available resources to resolve issues
- Independently prioritize and organize own work to complete daily tasks within required business mandated time - frames
