Provider services representative vs provider relations representative

The differences between provider services representatives and provider relations 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 services representative and a provider relations representative. Additionally, a provider relations representative has an average salary of $40,957, which is higher than the $33,858 average annual salary of a provider services representative.

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

Provider services representative vs provider relations representative overview

	Provider Services Representative	Provider Relations Representative
Yearly salary	$33,858	$40,957
Hourly rate	$16.28	$19.69
Growth rate	-4%	-4%
Number of jobs	252,118	203,893
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 41%	Bachelor's Degree, 58%
Average age	40	40
Years of experience	12	12

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.

What does a provider relations representative 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.

Provider services representative vs provider relations representative salary

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

	Provider Services Representative	Provider Relations Representative
Average salary	$33,858	$40,957
Salary range	Between $24,000 And $46,000	Between $30,000 And $55,000
Highest paying City	New York, NY	Helena, MT
Highest paying state	New York	Montana
Best paying company	Oracle	Parkland Hospital
Best paying industry	Health Care	Health Care

Differences between provider services representative and provider relations representative education

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

	Provider Services Representative	Provider Relations Representative
Most common degree	Bachelor's Degree, 41%	Bachelor's Degree, 58%
Most common major	Business	Business
Most common college	-	-

Provider services representative vs provider relations representative demographics

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

	Provider Services Representative	Provider Relations Representative
Average age	40	40
Gender ratio	Male, 22.2% Female, 77.8%	Male, 24.2% Female, 75.8%
Race ratio	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%	Black or African American, 12.1% Unknown, 5.3% Hispanic or Latino, 21.8% Asian, 6.5% White, 53.7% American Indian and Alaska Native, 0.7%
LGBT Percentage	7%	7%

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

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.

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.

Provider services representative vs provider relations representative skills

Common provider services representative skills

Customer Service, 24%
Data Entry, 6%
Patients, 5%
Medicaid, 5%
Health Insurance, 4%
Appeals, 3%

Common provider relations representative skills

Customer Service, 16%
Provider Relations, 9%
Medicaid, 9%
Patients, 6%
Health Plan, 5%
PowerPoint, 4%

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Provider Services Representative
Provider Services Representative vs Provider Relations Representative

Updated January 8, 2025

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