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Provider relations specialist vs provider services representative

The differences between provider relations specialists and provider services representatives can be seen in a few details. Each job has different responsibilities and duties. It typically takes 6-12 months to become both a provider relations specialist and a provider services representative. Additionally, a provider relations specialist has an average salary of $44,403, which is higher than the $33,858 average annual salary of a provider services representative.

The top three skills for a provider relations specialist include provider relations, medicaid and health plan. The most important skills for a provider services representative are customer service, data entry, and patients.

Provider relations specialist vs provider services representative overview

Provider Relations SpecialistProvider Services Representative
Yearly salary$44,403$33,858
Hourly rate$21.35$16.28
Growth rate-4%-4%
Number of jobs70,700252,118
Job satisfaction--
Most common degreeBachelor's Degree, 59%Bachelor's Degree, 41%
Average age4040
Years of experience1212

What does a provider relations specialist do?

Provider relations specialists are professionals who work for insurance companies as the primary contact for health care providers such as clinics and hospitals. These specialists are required to provide answers about service contracts and billing procedures to health care providers. They must handle the documents of patients to ensure that proper paperwork has been filed for coverage while developing communications with providers about any policy changes. Provider relations specialists must also travel to different health care organizations to provide training to their staff on insurance policies and procedures.

What does a provider services representative do?

A provider services representative is responsible for supporting, developing, and maintaining service relationships with involved participants, including providers, physicians, and administrators. Your duties typically include responding to direct and electronic questions from clients about rates, policies, referrals, and eligibility, handling telephone calls for the provider and member inquiries, and resolving complaints by the member and member representative. In addition, you will be assisting in collecting supporting data and documentation about the member's care. You are also expected to conduct research to be able to provide a well-informed answer to members' inquiries.

Provider relations specialist vs provider services representative salary

Provider relations specialists and provider services representatives have different pay scales, as shown below.

Provider Relations SpecialistProvider Services Representative
Average salary$44,403$33,858
Salary rangeBetween $30,000 And $65,000Between $24,000 And $46,000
Highest paying City-New York, NY
Highest paying state-New York
Best paying company-Oracle
Best paying industry-Health Care

Differences between provider relations specialist and provider services representative education

There are a few differences between a provider relations specialist and a provider services representative in terms of educational background:

Provider Relations SpecialistProvider Services Representative
Most common degreeBachelor's Degree, 59%Bachelor's Degree, 41%
Most common majorBusinessBusiness
Most common college--

Provider relations specialist vs provider services representative demographics

Here are the differences between provider relations specialists' and provider services representatives' demographics:

Provider Relations SpecialistProvider Services Representative
Average age4040
Gender ratioMale, 22.0% Female, 78.0%Male, 22.2% Female, 77.8%
Race ratioBlack or African American, 11.6% Unknown, 5.1% Hispanic or Latino, 21.4% Asian, 7.3% White, 53.9% American Indian and Alaska Native, 0.7%Black or African American, 11.5% Unknown, 5.1% Hispanic or Latino, 20.4% Asian, 6.4% White, 55.9% American Indian and Alaska Native, 0.7%
LGBT Percentage7%7%

Differences between provider relations specialist and provider services 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 services representative example responsibilities.

  • Coach, evaluate and performance manage MSRs to ensure timely and accurate service to clients.
  • Achieve excellent customer satisfaction ratings as documented by CIGNA surveys.
  • Proof reading contracts in order to adjust claims according to proper DRG, ICD-9, and CPT codes.
  • Complete the surgery schedule and ensure all patients are aware of their financial responsibility prior to the surgery date.
  • Help providers with all information about CPT codes such as authorizations, restrictions, fee schedules, and correct diagnosis codes.
  • Register patients for surgery in computer system.
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Provider relations specialist vs provider services representative skills

Common provider relations specialist skills
  • Provider Relations, 14%
  • Medicaid, 11%
  • Health Plan, 8%
  • Orientation Materials, 6%
  • Issue Resolution, 6%
  • Claims Submission, 4%
Common provider services representative skills
  • Customer Service, 24%
  • Data Entry, 6%
  • Patients, 5%
  • Medicaid, 5%
  • Health Insurance, 4%
  • Appeals, 3%

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