Provider Relations Representative in Miami Lakes, Florida at ClareMedica Health Partners LLC

Position Title: Provider Relations Representative

Location: Miami Lakes, FL 33016; Miami, FL 33126

Description:
At Claremedica, exceptional is the standard.
Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the Claremedica team is comprised of the brightest and best in their fields of expertise. From clinical excellence to unparalleled administrative support and beyond, we’re working together to help seniors live happier, healthier, fuller lives.

That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees’ growth and wellness and where their full potential and value are realized. At Claremedica, we’re excited about great people like you. We’re even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities.
Opportunity awaits – welcome to Claremedica.

ESSENTIAL FUNCTIONS
The Provider Relations Representative supports the specialty network of providers, ensuring access to quality healthcare services. He/She plays a pivotal role in fostering and maintaining strong and effective relationships with the network. The role ensures that providers are well-informed, complaint with policies, and contributing to the overall success and efficiency of the specialty network.

DUTIES AND RESPONSIBILITIES

Support, develop and maintain service relationships with all participants (physicians, providers and administrators) of a provider network

Respond to electronic and direct inquiries from clients about policies, rates, changes, referrals, eligibility, credentialing, etc.

Assist with monitoring and proper filing of all provider contracts

Coordinate and tracks all provider audits and re-credentialing including running reports as needed

Ensure all provider documentation is complete and accurate, including provider data entered into the provider database and Insite

Maintain and update preferred provider network data/reports

Resolve administrative concerns affecting network providers under their contract guidelines

Communicate provider status with centers and departmental leads

Resolve any and all concerns presented by providers and advise them on new and existing policies and procedures

Coordinate EHR training upon on-boarding

Coordinate and communicate in-house specialist schedules

SUPERVISORY RESPONSIBILITIES

This position does not have supervisory responsibilities.

QUALIFICATIONS/REQUIREMENTS

Bachelor’s degree

2+ years of experience in provider relations

Must speak English & Spanish fluently

Strong communication and interpersonal skills, with the ability to build rapport with healthcare professionals

Strong organizational skills with attention to detail and ability to manage multiple priorities

WORKING CONDITIONS
General office working conditions.

PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.

While performing the duties of this job, the employee will be required to stand, walk, sit, use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch or crawl; talk or hear. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust your focus. Manual dexterity is required to use desktop computers and peripherals.

WORK ENVIRONMENT
The work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of his job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

TRAVEL
Local travel between care centers and network providers’ offices is required.

SAFETY HAZARD OF THE JOB
Minimal Hazards


This job description does not list all the duties and responsibilities of the job. You may be asked by supervisors or managers to perform other instructions, duties, and responsibilities, as appropriate. You will be evaluated in part based upon your performance of the duties and responsibilities identified in this job description.

Management has the right to revise this job description at any time. The job description is not a contract for employment, and either you or the employer may terminate employment at any time, with or without cause, with or without notice.