Provider Relations Representative

Adecco is recruiting for a leading provider of vision and eye health solutions. If you meet the qualifications, please apply!

Scope and Purpose of Position

The Provider Relations Representative is an experienced customer service professional with excellent interpersonal, verbal and written communication skills.  The Provider Relations Representative serves as the first point of contact for Superior Vision’s provider network.  This individual will have the skill set to analyze and problem solve any claims-related issues and make system updates to provider demographic information as needed.  This individual must have excellent organizational skills and be able to multi-task.  The Provider Relations Representative will assist the Provider Relations Managers with network recruitment activities and provider network updates.  He or she will prepare documents for Credentialing, as well as, review and monitor provider complaints, grievances, and escalated issues as necessary to the appropriate staff.

Essential Functions

  • Serve as initial contact and responder to all provider related inquiries with exceptional service and timely responses in a professional and courteous manner.
  • Resolve and respond to provider claims issues and complaints:
  • Identify and correct fee schedule issues
  • Submit requests for adjustments to Claims
  • Provide education to providers and their office staff regarding processes and changes.
  • Accurately update systems with changes in provider information.
  • Process recruitment materials and applications received from providers.
  • Assist in recruitment projects, network comparisons and data entry.
  • Initiate improvements to processes and procedures for Provider Relations that support company and departmental standards and strategic directives.
  • Perform other related duties as assigned.

Education & Experience

  • High school diploma or equivalent is required.  Associates Degree is preferred.
  • Requires three (3) or more years of Customer Service and administrative experience. 
  • Previous health care experience in a managed health care environment, provider relations or customer service, including working with members and providers is preferred.  Understanding of vision care insurance is a plus.

Competencies

  • Must possess excellent verbal and written communication skills to communicate with providers via phone and written correspondence.
  • Requires accurate and efficient data entry skills 
  • Proficiency in database programs 
  • Proficient in Microsoft Access, Excel, and Word (intermediate level)
  • Ability to coordinate, track and efficiently organize multiple tasks and projects 
  • Detail-oriented 
  • Team player with the ability to be flexible and supportive of others in the department and company  
  • Strong problem solving skills 
  • Ability to work independently with moderate supervision 
  • Strong work ethic and desire to succeed
  • Ability to understand contract language and fee schedules
  • Develop and maintain effective working relationships with internal staff
  • Support the company and department mission, goals and objectives

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

The Company will consider for employment qualified applicants with arrest and conviction records.

  • Apply with Adecco

Reference number US_EN_99_025133_620925