Provider Relations Representative

Job description

The Provider Relations Representative for the Western Region will cover the following (and possibly additional surrounding) counties: Allegany, Cattaraugus, Chautauqua, Genesee, Livingston, Orleans, and Wyoming. Applicants who reside in Jamestown, Olean, Ellicottville, Dunkirk, Houghton, and surrounding cities are encouraged to apply. Responsible for maintaining working relationships within all vendors, both out-of-network vendors and within the provider network, as well as community relations contacts. Maintain accurate and current provider databases relating to provider facilities and credentialing information. Perform audits of electronic provider files, credentialing, contracting materials and claims submissions to ensure all contracted providers follow policies and procedures. Requirements: - Assists in the day-to-day operations of the Provider Relations department. - Research, contacts, and works to secure agreements with vendors who provide covered services in compliance with plan requirements. Obtains new service provider application and all necessary credentialing, and forwards to Provider Relations Credentialing & Contract Management Specialists to be processed. - Prepare...