Provider relations specialist vs provider relations representative

Differences between provider relations specialist and provider relations representative duties and responsibilities

Provider relations specialist example responsibilities.

• Design short and long term plans for PCPs to accomplish suggest benchmarks and growth of its membership.
• Provide keen oversight in developing and maintaining quality improvement programs while managing payroll.
• Organize and analyze CMS changes for distribution to the team.
• Meet or exceed productivity and quality goals base on CMS guidelines/directives.
• Establish and maintain positive and productive relations with network providers for Medicaid and Medicare.
• Assist in IPA profitability through the recruitment and contracting of key physicians, hospitals and ancillary organizations with target membership panels.
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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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