Provider relations representative vs contact representative

Differences between provider relations representative and contact 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.
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Contact representative example responsibilities.

• Perform outbound telemarketing, marketing products and services to members and attain sale goals.
• Lead contact center in consultation to patient's/doctors inquiring about Medicaid/Medicare coverage and claims.
• Contact doctor offices to schedule Medicade and Medicare risk adjustment chart reviews.
• Create common knowledge documents (CKM) to help agents resolve technical blackberry problems.
• Answer questions relating to VA and treasury offsets on collection procedures for past due accounts.
• Investigate and initiate corrective action on delays or errors and explain determination on individual cases and appeals.
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