Provider Relations Representative
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Saco, ME 04072
• Receive and effectively respond to external provider related issues
• Provide education on health plan’s innovative contracting strategies
• Initiate data entry of provider-related demographic information changes and oversee testing and completion of change requests for the network
• Investigate, resolve and communicate provider claim issues and changes
• Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
• Perform provider orientations and ongoing provider education, including writing and updating orientation materials
• Ability to travel
Education/Experience: Bachelor’s degree in related field or equivalent experience. 0-2 years of provider relations or contracting experience. Knowledge of health care, managed care, Medicare or Medicaid. Bachelor’s degree in healthcare or a related field preferred. Claims billing/coding knowledge preferred.
Licenses/Certifications: Current state driver’s license.