Provider relations representative vs business representative

Differences between provider relations representative and business representative duties and responsibilities

Provider relations representative example responsibilities.

• Help manage ACO program and review measures with provider offices.
• Advise clients on health care and manage care products including POS, PPO and medical management programs.
• Provide keen oversight in developing and maintaining quality improvement programs while managing payroll.
• Manage software maintenance renewal partner and assist with upselling additional and higher functionality licenses to increase revenue.
• Review the provider contracts, paid members claims, base on the CPT code & ICD-9 that are submitted.
• Review provider claims for CPT and ICD-9 coding accuracy and generate payment of claims base upon current fee schedule.
Show more

Business representative example responsibilities.

• Manage customer relations with internal personnel, group administrators, brokers and members as related to Medicare insurance.
• Verify ICD-9 to physician's diagnosis; insure correct CPT codes and level of service are going out on claims.
• Handle incoming calls to investigate and troubleshoot network and hardware concerns that align with company expectations of quality.
• Utilize multiple internal information systems and applications to troubleshoot hardware issues.
• Verify all new and returning patients' insurance coverage and eligibility when reviewing patient registration.
• Obtain and verify accurate and complete patient demographic information, appropriately schedule patients according to center and insurance guidelines.
Show more