Provider relations representative vs representative

Differences between provider relations representative and 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

Representative example responsibilities.

• Manage fitting rooms and recover the department, while providing exceptional customer service and offering rewards and POS options.
• Manage physical portfolio with necessary derivatives to mitigate risk within company guidelines.
• Conduct telephone sales and interviews, compile and enter information into database, manage documents and insure customer satisfaction.
• Review EOB denials, appeals and/or rebilling as appropriate.
• Certify of all requirements, policies, and procedures, including MSB.
• Take inbound phone calls from member and providers explaining the EOB denial and payments
Show more