Provider relations representative vs phone representative

Differences between provider relations representative and phone 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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Phone representative example responsibilities.

• Conduct telephone sales and interviews, compile and enter information into database, manage documents and insure customer satisfaction.
• Provide status of medical claims and explain EOB's.
• Research and resolve incorrect payments, EOB rejections and other issues with accounts.
• Answer inbound provider calls to help with billing Medicaid claims and benefits and eligibility issues.
• Update alumni on current happenings in university life and act as a liaison between past and current students.
• Contact hundreds of alumni and their families by telephone and raise thousands of dollars to improve school facilities and maintain school grounds
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