- UpvoteDownvoteShare Job
- Suggest Revision
External Provider Relations and Provider payment reviews including payment integrity. They will also work with other departments including Claims Operations, Actuarial, and Quality Management and could assist with performing clinical reviews of provider claims payment disputes, perform retrospective claims audits of medical records, review of potential quality of care issues as well as credentialing of Providers and Facilities.
$271,866 - $351,826 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Provider Relations Representative works as the primary liaison between Community First Health Plans and network participants (physicians, providers, and administrators) of the health plan provider network.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Recent experience as a provider relations representative, member service representative, or relevant claim experience is highly preferred. The Provider Relations Representative knows and abides by all organizational and departmental policies, sets personal standards, and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
ResponsibilitiesThe Provider Relations Representative is responsible for establishing and maintaining positive relationships with various clients building strong, cohesive business partnerships.
$24.96 - $34.31 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Render/provide appeal decisions following legacy Tufts Health Plan or Harvard Pilgrim Health Care claims payment policies. Utilization management, quality and / or management experience, either at another health plan or at a local provider unit, medical group, or health care facility is preferred.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Key stakeholder departments include, configuration, provider relations, provider credentialing, provider enrollment, claims, medical management and payment integrity.
ExpandUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Key responsibilities will include claims payment and remittance, network management, provider credentialing, data exchange and reporting and quality oversight. Requires a BA/BS degree and a minimum of 5 years’ experience in contracting, provider relations, provider servicing; experience should include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.
$64,000 - $115,200 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Sante Health System provides numerous client services such as billing, claims processing, contracting, credentialing, finance, human resources, information services, marketing/communications, physician services, practice management, provider relations, quality improvement, and utilization management.
$16 - $24 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
The Director coordinates with all functional areas of shared services partners, including but not limited to clinical operations, quality management, network development and management, provider relations, member outreach, education and member services, contract compliance and operations including claims and reporting.
Full-timeRemoteExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Responsibilities include; stewardship of Patient Billing and Collection, A/R Management, Application Systems Support, Claims Management, Coding, Charge Capture, Data Entry, Account Follow-Up, Customer Service, Denial Management, Edit Management, Payment Variance Analysis, Contract Analysis, Credit Analysis, Refund Management, Payment Posting, Auditing, Training, and Productivity and Performance Reports.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Prefer experience in Health Plan Services, Provider Relations, Member Relations, Healthcare Marketing & Engagement, or Claims. Helps Provider Relations & Engagement Specialist in obtaining provider information for QNXT such as TIN, NPIs and other information as needed.
$60,314 - $87,695 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Work closely with teams focused on provider performance to promote actionable reporting and metrics for provider performance improvement. Serve as physician provider liaison for case management teams, meeting with decision makers in the provider community, convening interagency case conferences to improve and implement plans of care.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Directs and coordinates day-to-day plan functions, including Reporting, Claims Administration, Encounter Data Quality, Grievance and Appeals, Information Technology and Systems, Enrollee Services, Provider Services, and Business Continuity Planning and Emergency Coordination.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Experience working with payer provider relations teams on trending payer issues, as well as working cross functionally with other teams (including credentialing, support, contracting, account management) to improve internal workflows.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Acts as a liaison between strategic providers and Beacon clinical, quality, provider strategy, network departments, operations, claims and provider relations to ensure interdepartmental collaboration and coordination of goals and priorities and to support linkages for issue resolution, helping to improve provider experience and overall satisfaction with Beacon.
ExpandApply NowActive JobUpdated Today
provider relations claims jobs
FEATURED BLOG POSTS
What is Seasonal Employment?
Depending on where you are in your career, you might have first-hand experience with seasonal employment. Seasonal employment can be a great way to expand your skill set and earn extra cash while helping businesses meet seasonal increases in demand.
How to Avoid a Bad Hire
"A new employee who doesn't meet the minimum performance, quality, and culture fit standards you set when you began sourcing and recruiting. Additionally, bad hires will immediately show signs of self-interest instead of an interest in their role and the company."
How to Ask for a Letter of Recommendation
When the job board you subscribe to finally posts your dream job, you may feel like the stars have aligned. But part of securing a position that matches your career plan is ensuring you address all the application basics. You know, the resume, the cover letter, the portfolio. It seems like you've got this in the bag — until you realize they want a letter of recommendation, too!
16 Tech Jobs You can Get Without a College Degree
You might think that if you don’t have a computer science, information technology, or related degree, then there’s absolutely no way you can break into the technology field and score a high-paying tech job. But this is a misconception. There are actually tons of tech jobs out there that don’t require a college degree. Instead, employers are more interested in the skills that you can offer. So, read on to learn more about how to land tech jobs without a degree.
What Are SMART Goals?
When it comes to achieving our goals, there’s a lot of noise to work through. A study by the University of Scranton has found that only 8% of people who set New Year’s resolutions actually achieve them. Our busy lives might be one reason for this. Another, even more important reason, is our approach to goal setting. Being too vague, too ambitious or simply unclear on the timeframe can set us up for failure.
The Best Remote Jobs: Where & How to Find Them
The Covid-19 pandemic hasn’t been easy on any of us, but if there’s one silver lining, it’s the fact that remote work has grown in popularity because of it. Companies that previously weren’t open to their employees working remotely were suddenly forced into allowing it. Since then, they've realized that much of their workforce is happier and more productive. Naturally, this has led to more remote job openings, which is great if you’re interested in this type of position. Read on to learn more about the best remote jobs and where to find them.
In-House vs Outsourcing Recruiting: Which is Better?
When looking at in-house vs outsourcing recruiting, it is important to nail down the benefits for each and whether those benefits outweigh the risks that follow.