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Provider relations specialist vs resolution specialist

The differences between provider relations specialists and resolution specialists 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 resolution specialist. Additionally, a provider relations specialist has an average salary of $44,403, which is higher than the $38,984 average annual salary of a resolution specialist.

The top three skills for a provider relations specialist include provider relations, medicaid and health plan. The most important skills for a resolution specialist are patients, phone calls, and appeals.

Provider relations specialist vs resolution specialist overview

Provider Relations SpecialistResolution Specialist
Yearly salary$44,403$38,984
Hourly rate$21.35$18.74
Growth rate-4%-4%
Number of jobs70,700152,590
Job satisfaction--
Most common degreeBachelor's Degree, 59%Bachelor's Degree, 45%
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 resolution specialist do?

A Resolution Specialist is responsible for investigating claims and analyzing supporting documents to resolve complaints. Resolution Specialists may work for clients' disputes or employee relations, requiring them to have extensive knowledge of labor laws and regulatory policies. They conduct cross-examinations, administer negotiations, and discuss processes with the clients for high-level violations. A Resolution Specialist must have excellent communication and organizational skills, especially in representing the client and the company and coming up with the resolution that would work for both's best interests.

Provider relations specialist vs resolution specialist salary

Provider relations specialists and resolution specialists have different pay scales, as shown below.

Provider Relations SpecialistResolution Specialist
Average salary$44,403$38,984
Salary rangeBetween $30,000 And $65,000Between $26,000 And $57,000
Highest paying City-Ewing, NJ
Highest paying state-Connecticut
Best paying company-IBM
Best paying industry-Finance

Differences between provider relations specialist and resolution specialist education

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

Provider Relations SpecialistResolution Specialist
Most common degreeBachelor's Degree, 59%Bachelor's Degree, 45%
Most common majorBusinessBusiness
Most common college--

Provider relations specialist vs resolution specialist demographics

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

Provider Relations SpecialistResolution Specialist
Average age4040
Gender ratioMale, 22.0% Female, 78.0%Male, 36.8% Female, 63.2%
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, 11.4% Unknown, 5.3% Hispanic or Latino, 19.7% Asian, 7.0% White, 55.8% American Indian and Alaska Native, 0.7%
LGBT Percentage7%7%

Differences between provider relations specialist and resolution specialist 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.
  • Show more

Resolution specialist example responsibilities.

  • Used software tools including: microsoft excel, powerpoint, outlook.
  • Provide members with accurate and appropriate information to answer questions, troubleshoot issues, and resolve member complaints.
  • Respond to service inquiries regarding existing deposit accounts, ATM and debit cards, consumer loans and eCommerce applications.
  • Contribute written materials and course content for exercises to NADL training and content to PowerPoint presentations as subject matter expert.
  • Analyze, troubleshoot, and resolve complex software, hardware, and networking issues for small and large business owners.
  • Contact federal (Medicare, TRICARE), state (Medicaid), and private health insurance companies for lien information.
  • Show more

Provider relations specialist vs resolution specialist skills

Common provider relations specialist skills
  • Provider Relations, 14%
  • Medicaid, 11%
  • Health Plan, 8%
  • Orientation Materials, 6%
  • Issue Resolution, 6%
  • Claims Submission, 4%
Common resolution specialist skills
  • Patients, 15%
  • Phone Calls, 7%
  • Appeals, 6%
  • CPT, 5%
  • Inbound Calls, 4%
  • PowerPoint, 4%

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