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Manager, provider relations skills for your resume and career

Updated January 8, 2025
4 min read
Below we've compiled a list of the most critical manager, provider relations skills. We ranked the top skills for managers, provider relations based on the percentage of resumes they appeared on. For example, 15.3% of manager, provider relations resumes contained medicaid as a skill. Continue reading to find out what skills a manager, provider relations needs to be successful in the workplace.

15 manager, provider relations skills for your resume and career

1. Medicaid

Here's how managers, provider relations use medicaid:
  • Managed unit responsible for developing provider re-enrollment forms and processes needed to re-enroll 14,000 Medicaid providers within six months.
  • Provided education and clarification to hospitals regarding MassHealth policies, Massachusetts Medicaid law/regulations and the utilization review process.

2. Patients

Here's how managers, provider relations use patients:
  • Coordinated with Regional Clinical Director to work with renowned local cardiologist on developing cardiac protocols for hospice patients.
  • Negotiated a contract with a dispensing/repacking company to provide medication to contracted physicians for their patients -3-

3. Network Development

Network development is the process of scaling, developing and automating digital networks so that companies can process data more efficiently. Network development is generally carried out by a network engineer.

Here's how managers, provider relations use network development:
  • Promoted to Senior Director of Network Development overseeing all of Network Development and Provider Relations.
  • Participate with executive staff in business development activities to evaluate and execute network development activities.

4. Oversight

Having oversight of someone means to monitor a process or a situation. If someone has oversight of something, they are responsible for the completion of the project. Oversight is usually given to experts as they monitor their juniors or newbies as they go through a project.

Here's how managers, provider relations use oversight:
  • Participated in client delegation oversight audits to ensure compliance of Credentialing files.
  • Negotiated provider contracts and provided oversight of 300+ provider relationships.

5. HMO

Here's how managers, provider relations use hmo:
  • Trained new provider offices in implementing the HMO & PPO plans in to their office procedures.
  • Completed a five week Up-training course with 100% ~ PIE Processing Department - HMO Department.

6. Training Programs

Here's how managers, provider relations use training programs:
  • Devised highly effective network provider training programs with area and regional management.
  • Devised operational training strategies and materials for training programs.

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7. Process Improvement

Here's how managers, provider relations use process improvement:
  • Retained and managed successfully highly sensitive national providers because of processing conflicts through strong relationship building and intense strategic process improvements.
  • Identified opportunities and actively participate in process improvements related to enhancing health plan quality.

8. Health Plan

Here's how managers, provider relations use health plan:
  • Coordinated Joint Operations Meetings with hospitals in respective territories and established strong relationships with health plans.
  • Renegotiated provider contracts in a manner favorable to health plan requirements.

9. NCQA

Here's how managers, provider relations use ncqa:
  • Established and automated credentialing policies and procedures that passed NCQA standards upon first examination.
  • Implemented and maintained provider and vendor contracts, communication and processes to assure credentialing, quality compliance and three-year NCQA accreditation.

10. Direct Reports

Here's how managers, provider relations use direct reports:
  • Hire, train, coach and evaluate performance of 7-12 direct reports.
  • Managed business analyst group, 6 direct reports.

11. Provider Contracts

The definition of a provider contract is 'an agreement between a contracting entity and a provider according to which the provider agrees to deliver medical services to a claimant under this title in exchange for payment or reimbursement of an agreed-upon amount.' A provider contract relates to exactly one business partner. It consists of a contract header and contract items and details like contract start date, contract end date, authorization group, company code for authorization checks and the number of the business partner who entered the provider contract.

Here's how managers, provider relations use provider contracts:
  • Negotiated provider contracts and reimbursement utilizing fee schedules and capitation for hospitals, ancillary providers, primary care and specialty care.
  • Work with Utilization Management Director regarding incorporation and enforcement of Utilization Management provisions incorporated into provider contracts.

12. Issue Resolution

Issue resolution refers to a set of processes that can be used to resolve an issue, conflict, dispute, or claim, and the ability to deal with the problems that need to be resolved, the decisions that need to be made, and the risks that need to be mitigated. Essentially, an issue resolution process intends to make it easier for people to come to a resolution following an issue.

Here's how managers, provider relations use issue resolution:
  • Managed provider relations issue resolution, education and orientation.
  • Provided service and issue resolution to existing providers.

13. Problem Resolution

A problem resolution refers to how a person identifies the problem, determining its cause, creating a reasonable solution, and implementing a conclusion. With the help of a client specialist, it is easier to handle such a situation. Problem resolution plays a vital role in helping resolve problems efficiently and effectively.

Here's how managers, provider relations use problem resolution:
  • Coordinated and monitored problem resolution of behalf of providers and administration.
  • Trained staff on provider communications, policies and procedures, contractual terms and conditions, and problem resolution.

14. Provider Satisfaction

Here's how managers, provider relations use provider satisfaction:
  • Developed and implemented a Paperless Referral Program resulting in an increase in Provider Satisfaction and claims payment accuracy.
  • Project lead for external Provider Satisfaction, internal Satisfaction, Outpatient Laboratory/Radiology and After Hours Surveys.

15. Appeals

Here's how managers, provider relations use appeals:
  • Maintained Appeals and Grievance process to assist providers in claims submission and analysis of operational issues concerning customer satisfaction.
  • Identified/researched and resolved issues including claims, customer service, capitation, benefit eligibility, appeals and grievances.
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List of manager, provider relations skills to add to your resume

Manager, provider relations skills

The most important skills for a manager, provider relations resume and required skills for a manager, provider relations to have include:

  • Medicaid
  • Patients
  • Network Development
  • Oversight
  • HMO
  • Training Programs
  • Process Improvement
  • Health Plan
  • NCQA
  • Direct Reports
  • Provider Contracts
  • Issue Resolution
  • Problem Resolution
  • Provider Satisfaction
  • Appeals
  • CPT
  • Provider Data
  • Provider Issues
  • PPO
  • Business Development
  • Data Analysis
  • IPA
  • Provider Education
  • Provider Community
  • Primary Care
  • Medicare Advantage
  • CMS
  • Fee Schedules
  • Network Adequacy
  • Claims Processing
  • PCP
  • Provider Complaints
  • Provider Inquiries
  • Provider Recruitment
  • EDI
  • Contract Implementation
  • Utilization Management
  • Contract Negotiations
  • Claims Issues
  • PHO
  • Care Contracts
  • Operational Issues
  • Primary Liaison
  • MCO
  • ACO
  • Medical Management
  • Claims Payments
  • Medical Professionals
  • Physician Recruitment

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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