Provider Relations Resume Sample

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Alexane Marquardt
120 Callie Harbor,  Boston, MA
+1 (555) 511 9738

Work Experience

Provider Relations Specialist
06/2016 - PRESENT
Dallas, TX
  • Provide onboarding support to new providers to include development of marketing materials, attendance at relevant department meetings, and physician office visits
  • Develop provider relationships to ensure that providers communicate problems and/or concerns as needed
  • Work with departments as needed for provider recruitment
  • Assist in implementation of marketing programs such as collateral, direct mail, advertising, web, audiovisual programs, publicity and special events
  • Coordinate promotion of events and activities involving our physicians and services
  • Develop, write and assist in implementing communication materials for newsletters, website newsletters, intranet and other communication vehicles
  • Provide communication support to administration, the charitable foundation, the guild, human resources, and other departments as necessary
  • Maintain regular communication with the departments, divisions and programs to seek guidance and direction as well as to keep informed of activities
  • Ensure that efforts are monitored, tracked, and reported to leaders of departments, divisions, and programs in a timely manner
Provider Relations Coordinator
08/2009 - 03/2016
Phoenix, AZ
  • Responds timely to CSR’s
  • Leads and develops a team of Provider Relations Reps and Provider Operation Coordinators
  • Leads and develops a team of Provider Relations Representatives and Network Management
  • Conducts ride-alongs with Representatives in the field to develop skills and behaviors and document progress/provide formative feedback through timely and consistent Field Trip Reports
  • Serves as single-point-of-contact to the physician network and is an accountable owner, responsive to physician needs. Knowledgeable about incentive programs, contract reimbursement, network, practice and network profitability, ACOs and other DMG initiatives, as applicable
  • Responds timely (within one business day) to provider issues, works with other groups/central departments to resolve issues and updates providers and office staff regularly until resolution
  • Is proactive in identifying issues and determining root cause so that they can be resolved timely and completely. Escalates certain issues as appropriate to leadership
  • Build collaborative relationships with IPA physicians and their office staff
Provider Relations Assistant
12/2003 - 07/2009
San Francisco, CA
  • Partners with field network teams and key shared services stakeholders to advance the execution of the Company’s value-based contracting strategy
  • Coordinates monthly communication forums with each State’s Network Leadership Team to ensure bi-directional flow of information on key issues, identify market support needs, and facilitate sharing of best practices
  • In collaboration with field network teams, design and execute major projects related to provider engagement and network solutions, including but not limited to continued evolution of Company’s Provider Engagement Model, Provider Contract Automation project, and Practice EMR Connectivity
  • Partners with Public Policy and local Government Affairs Teams to track and monitor emerging legislation related to provider networks (and specifically, value-based contracting). Assesses impact of legislation on WellCare’s business and leads the implementation of any corresponding action plans to respond
  • Partners with Business Development Team to support early-stage activities in new “greenfield” markets related to identifying (and in some cases, contracting ) with key provider partners to support WellCare’s RFP responses
  • Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer
  • Completes and routs paperwork to add, delete and/or change providers’ demographic information
  • Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards


University of Texas at Arlington - Fort Worth Campus
1997 - 2002
Bachelor's Degree in Health Care Administration

Professional Skills

  • Strong interpersonal skills and adaptive communication style, complex problem solving skills, drive for results, innovative
  • Proven ability to effectively problem solve while utilizing strong customer service skill sets
  • Strong time management, project management and organization skills with the ability to manage/support multiple projects and priorities
  • Demonstrated excellent communication and customer relation skills
  • Strong verbal and written communication skills and the ability to interact effectively with a diverse group of staff, executives and providers
  • Utilize time management skills - prioritizing and planning
  • Strong operational problem solving skills with a clear understanding of impacts on downstream departments

How to write Provider Relations Resume

Provider Relations role is responsible for customer, microsoft, advanced, interpersonal, database, training, computer, communications, healthcare, word.
To write great resume for provider relations job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Provider Relations Resume

The section contact information is important in your provider relations resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Provider Relations Resume

The section work experience is an essential part of your provider relations resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous provider relations responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular provider relations position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions.

Representative Provider Relations resume experience can include:

  • Well-developed sales, negotiation, customer service, and training skills
  • Identify staff training needs and provide ongoing training, as well as initial orientation, to ensure the effectiveness of Provider services staff
  • Collaborate with Service Center’s Provider Training Manager to ensure effective and appropriate training programs are developed and implemented
  • Validates client check list to ensure all medical bills are present before returning product to client
  • Assist in developing cost effective provider reimbursement methodologies
  • Prioritize multi-tasking responsibilities

Education on a Provider Relations Resume

Make sure to make education a priority on your provider relations resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your provider relations experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school

These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Provider Relations Resume

When listing skills on your provider relations resume, remember always to be honest about your level of ability. Include the Skills section after experience.

Present the most important skills in your resume, there's a list of typical provider relations skills:

  • Excellent written and oral communications skills, flexibility, problem solving ability, creativity, teamwork skills, and prioritizations skills required
  • Effectively deal with moderate levels of ambiguity (can effectively cope with change, can shift gears comfortably)
  • Good negotiation skills when interacting with internal and external stakeholders
  • A team player with strong listening skills
  • Proven analytical and financial skills LI-RG1
  • Prior negotiation experience; or any combination of education and experience, which would provide an equivalent background

List of Typical Experience For a Provider Relations Resume


Experience For Provider Relations Specialist Resume

  • Advanced Change Management and Communication Skills
  • Maintaining a valid NV driver’s license
  • Experience presenting to/training for large groups
  • Valid driver’s license, vehicle, and insurance required (mileage reimbursement)
  • Accountable for the external end-to-end provider experience for assigned Book of Business
  • Continually research effectiveness and implement improvements in provider relations best-practices
  • Solid knowledge of health plan operations required
  • Properly prioritize and manage assignments, scheduled or unscheduled
  • Checking voicemail, running phone reports, check off list on payment files and EOR’s scanning

Experience For Provider Relations Manager Resume

  • Conducting training webinars
  • Presenting at association meeting and Medicaid conferences
  • Developing training materials and presentations
  • Assisting providers with investigation of problematic claims, enrollment, or other issues
  • Developing relationships with the provider community

Experience For Provider Relations Coordinator Resume

  • Exercising independent judgment within generally defined policies and practices to identify and select a solution
  • Lead the Medical Scheduling clerks, directing scheduling work flow and helping to train Scheduling staff in new or revised unit procedures
  • Partner with the Compliance and Law departments to ensure that we are following state laws involving PPO contracts and Credentialing requirements
  • Logs all incoming and outgoing courier packages for tracking purposes
  • Assists management with identifying opportunities for staff improvement, high performing team members, and training needs of team members
  • Daily liaison for panel leasing arrangements including administration, customer complaint resolution, and claim discrepancy situations
  • Responsible for the credentialing and re-credentialing of our network providers

Experience For Manager, Provider Relations Resume

  • Responsible for the reporting of providers to the HealthCare Integrity and Protection Data Bank and related state licensing boards
  • Responsible for proofing and updating provider directories for assigned territories
  • Local travel. Early morning and evening meetings with IPA’s and PODS, as needed
  • Communicates provider demographic and reimbursement information for loading Networks into PBA systems and Member reference materials, including websites
  • Communicates with and manage chain and pharmacy payment administration, including bank routing
  • Local travel. Early morning and evening meetings with IPA’s and PODS as needed
  • Conducts market research and continuing education to stay current on clinical integration strategies and changing reimbursement models
  • Support all calling areas within Scheduling to meet Operations department service levels and KPI’s

Experience For Senior Provider Relations Coord Resume

  • Coordinate the contracting process with the credentialing process and in-service all departments when new agreements and Letters of Agreements are executed
  • Responsible for interacting with staff who are providing off site or telephone services to Providers
  • Acts as a mentor to junior team members by leading by example and guiding with a sense of integrity and team work
  • Performance reviews as and resource coaching and training as needed
  • Provide regular reporting to markets regarding Network Development Progress
  • Ensure targets for contracting and credentialing are meet each month
  • Ensure provider network success and customer service excellence by building and maintaining relationships with management at key associations/chains
  • Assist providers to facilitate successful credentialing and re-credentialing
  • Acts as a team mentor by leading by example and guiding with a sense of integrity and team work

Experience For Provider Relations Recruitment & Retention Representative Resume

  • Verify all provider signatures, contracts and documentation before submitting for internal processing
  • Responsible for assisting with the general oversight of provider network financials, including monthly action plans, reviews, trend analysis, and verification
  • Detail understanding of the HealthSpring P&L and the operational drivers that affect the results
  • Primarily local travel. Early morning and evening meetings with Physician Networks as needed
  • Provide quality customer service through daily contact with providers ensuring they are educated on all contractual issues

Experience For Provider Relations Associate Resume

  • Extensive knowledge and proficiency of the Managed Care imaging system
  • Partner with our Provider Network Representatives to help expand our growing network
  • Knowledge of PC and software including Word and Excel
  • Provides in-services on billing, reimbursement, referrals, authorizations, website, etc
  • Communicates and provides written information regarding new products and new groups
  • Develops, plans, organizes and/or conducts orientation, training, and education meetings/programs

Experience For Provider Relations Consultant Resume

  • Works with key providers and/or risk partners in maintaining an adequate provider network by identifyingprovider network gaps in assigned territories
  • Point of contact for additions or deletions to existing contracted provider groups and individuals
  • Assists in delivering key executed contracts
  • Opens and distributes incoming mail for Provider Relations department
  • Coverage area – Atlanta and surrounding counties
  • Make outgoing follow up calls for timely issue resolution
  • Administration of provider contracts, including proper implementation of reimbursement terms

Experience For Provider Relations & Contracting Manager Resume

  • Proactively educate and influence providers on CIGNA's business objectives, standard operating procedures, policies and programs
  • Identifies provider education opportunities and provides proactive training on a continuous basis
  • Participates in presentations to existing and prospective providers and/or clients
  • Processes and responds to providers interested in joining Beacon’s network
  • Supports clinical teams in troubleshooting network challenges

Experience For Coord Provider Relations Resume

  • Responds to routine telephone inquires and make call backs within the same day or following day
  • Performs stewardship meeting with high volume providers
  • Develop stewardship reports including monthly revenue and savings reports, and surveys
  • Knowledge of ancillary and diagnostic imaging operations
  • Positive completion of a Nevada fingerprinting and Federal background check
  • Meet or exceed administrative budget targets and rate contracting targets
  • Act as liaison and maintain productive working relationships with all Beacon departments
  • Hire, manage and develop a high-performing team

List of Typical Skills For a Provider Relations Resume


Skills For Provider Relations Specialist Resume

  • Strong critical thinking skills, listening, and problem solving skills
  • Strong oral and written skills with the ability to make effective group presentations and consensus building
  • Management experience or 3+ years in a Supervisory, or Lead/Sr. role with demonstrated leadership ability or program management experience Required
  • Intermediate - Demonstrated leadership skills
  • Excellent customer service skills, preferably in a provider services call center
  • Strong long distance communication skills necessary for both internal and external communications

Skills For Provider Relations Manager Resume

  • Presenation skills to communicate business plans in an effective manner
  • Excellent organizational skills, attention to detail and ability to look at the bigger picture
  • Strong project management skills are a necessity
  • Process-oriented with strong organization and planning skills
  • Proven program implementation skills
  • Demonstrated professional and technical writing skill
  • Advanced problem-solving skills, and attention to detail required.

Skills For Provider Relations Coordinator Resume

  • PC skills required, including MS Office applications such as Word, Excel, PowerPoint and Outlook.
  • Skilled Nursing, Home health or hospice experience
  • Be able to de-escalate situations effectively
  • Interact with all levels of management effectively
  • Provider perspective as evidenced by two year’s experience in a healthcare setting
  • Healthcare experience with strong background in provider relations
  • Intermediate to advanced skills in Microsoft office and other related software/programs
  • Self-motivated; ability to effectively communicate and negotiate routine and complex issues

Skills For Manager, Provider Relations Resume

  • Advanced written and oral communication skills required.
  • Some analytical skills required.
  • Experience in a claims, customer service or provider support role or equivalent military experience
  • Advanced - Facilitative skills
  • Effective communication (written and oral) and interpersonal skill
  • Demonstrated experience developing successful working relationships with physicians
  • Effectively manage provider accounts resulting in provider retention
  • Exceptional computer skills, including Microsoft Office applications (with emphasis in Word, Power Point, Excel, Project and Publisher)
  • Technical: Computer skills: Excel, Power Point, Word

Skills For Senior Provider Relations Coord Resume

  • Advanced Microsoft Excel skills with V Lookups, Pivot Tables and ability to utilize formulas
  • Experience with Microsoft Excel including basic formulas, analyzing data, filtering and sorting
  • Organizations, time management, managing work flow, prioritizing and multi-tasking
  • Experience with provider contracting and credentialing in a managed care setting
  • Experience with MS Excel - editing and creating spreadsheets, formulas, sorting
  • Professional experience in data modeling, trending, and forecasting
  • Experience developing and implementing Optum strategic business initiatives for nationwide clinical programs
  • Demonstrate continued value of fitness programs by developing and delivering tools for partners that result in the retention of quality network providers

Skills For Provider Relations Recruitment & Retention Representative Resume

  • Experience with MS Word - editing and creating docs
  • Demonstrated ability to work independently, utilize computer-based tools including e-mail, word processing, database management, and spreadsheets
  • Experience working in a medical office setting
  • Develop educational messages and materials for existing Providers to promote understanding of policies and procedures as well as good business practices
  • Demonstrate an appropriate level of assertiveness in performing work responsibilities and in making work related decisions
  • Experience within provider relations in a managed care setting
  • Work in an expeditious fast pace with changing priorities
  • Establish and maintain effective working relationships with peers, employees, and providers

Skills For Provider Relations Associate Resume

  • Professional experience in a managed care setting
  • Experience using Microsoft Excel and Microsoft Word
  • Experience using the Internet and databases as research tools
  • Ten-twelve (10-12) years of progressively responsible professional experience, with at least three (3) of those years with a client-facing role
  • Experience working in Provider Relations
  • Experience with claims resolution and familiarity with credentialing processes
  • Deliver presentations to small and large groups to explain and demonstrate the benefits of being a Tivity Health fitness network provider

Skills For Provider Relations Consultant Resume

  • Experience with MS PowerPoint - can create presentation for reporting purposes
  • Previous experience interacting with physicians in the private practice and in employed medical groups through verbal and written communication
  • Experience with the following systems: CARS, HMS, e-Docs, Business Objects, MS Excel, MS Access, MS SharePoint
  • Experience with credentialing of medical specialists
  • Good understanding of HMO systems’ provider reimbursement mechanisms
  • Experience in business segment environment servicing providers with exposure to benefits, claims and/or contract interpretation

Skills For Provider Relations & Contracting Manager Resume

  • Knowledge of and experience in provider benefits administration/health care setting and with providers and provider networks
  • Experience in Network development in a payer or provider setting
  • Experience with medical provider billing is helpful
  • PBM or related experience working with contracts or pharmacy claim detail
  • Three years of experience in Healthcare Industry (Customer Service, Appeals, Sales)
  • Interact with the public in an effective and courteous manner

Skills For Coord Provider Relations Resume

  • Previous experience in workers’ compensation industry
  • Experience with Medicare and Medicaid regulations
  • Work well with various Plan departments is instrumental in the effectiveness of the position
  • Proven knowledge of reimbursement methodologies and payment mechanisms
  • Experience in a deadline oriented environment
  • Excellent telephone communication with providers and internal staff
  • Experience in provider relations or similar background required
  • Experience in management required
  • Ensure appropriate and effective communication with the Clinical Team Managers in field within assigned territory

List of Typical Responsibilities For a Provider Relations Resume


Responsibilities For Provider Relations Specialist Resume

  • Travel extensively throughout the State of New York in order to conduct performance evaluation and monitoring of Provider Relations Field Representatives at Provider Training Seminars as well as to ensure provider needs are being met
  • Effective oral, and written and communication skills
  • Accomplished computing skills in database, spreadsheets and word processing
  • Strong customer service experience, preferably in a provider services call center
  • Communicate professionally and effectively with leadership and their support staff to ensure that appropriate meetings are scheduled timely
  • Clear communication skills both written and verbal
  • Work effectively in difficult situations
  • Experience in developing and negotiating provider networks, contracting with ancillaries and hospitals

Responsibilities For Provider Relations Manager Resume

  • Demonstrated knowledge of claims processes and procedures including coding such as CPT-4 and ICD-9/10
  • At least three years of training, communications, or marketing experience required
  • Strong focus on CRM management and reporting
  • Experience with applied statistical analysis, rate and cost comparisons, capitation formulations and provider risk pool sharing
  • Professional experience in a managed care setting
  • Previous experience interacting with providers
  • Customer service experience working in the Managed Care and Benefit Administration industries
  • Demonstrates knowledge of Providers and applicable geographic areas nationally

Responsibilities For Provider Relations Coordinator Resume

  • Completes quarterly data integrity validation process with each DPHO practice to confirm accuracy of data in DPHO’s databases
  • Valid AZ driver’s license
  • Ensure effective communication with other teams to assure APC Network Operations issues are managed quickly and efficiently
  • Develop strong provider and client relationships built on trust and collaboration. Manage and balance Beacon and provider expectations
  • Three (3) years of provider relations experience
  • Enterprise-wise program management experience

Responsibilities For Manager, Provider Relations Resume

  • Extensive knowledge and experience with a variety of compensation methodologies
  • Assists team members in completion of high priority tasks when necessary
  • Multi-task, prioritize work assignments, and work independently
  • Customer Service orientation / experience
  • Experience in leadership/team lead role
  • Identifying and addressing quality of care and service issues, in conjunction with clinical and medical departments
  • Working knowledge of FACETS claims processing system
  • Understanding of managed care within a provider office

Responsibilities For Senior Provider Relations Coord Resume

  • Billing practices in the health care industry
  • Typing speed of 45 wpm or better
  • Assists with problem solving and improvement of managed care portal including training, provisioning, workflow and functionality
  • Manages the dis-enrollment process by meeting with the practitioner or facility, confirming direction, and completing required paperwork for Network Operations
  • Prepares monthly reports and logs pertaining to incoming mail statistics for clients as requested
  • Credential providers, including collect application, review, and perform primary source verification on credentialing elements
  • Oversee performance of end-to-end provider contracting, claims servicing and call quality
  • Oversee educating key Nursing Home staff about United Healthcare systems
  • Review and direct scheduling work flow, assuring the proper number of Medical Schedulers is assigned to each task on a daily basis

Responsibilities For Provider Relations Recruitment & Retention Representative Resume

  • Assess and resolve specific provider concerns, developing and implementing solutions that are beneficial to providers, LHI Customers and LHI
  • Responsible for the timely processing of check requests and approving check requests as needed for staff
  • Problem solving of provider issues, health plan issues, and billing issues as they relate to health plan submissions
  • Provide support to the Quality Utilization Management Department in analyzing provider trends and developing action plans to effect change
  • Responsible for ongoing education and communication with providers including physicians, hospitals, ancillary, extended networksand tertiary providers
  • Competent in data management, strategic planning/goal setting, and conflict resolution

Responsibilities For Provider Relations Associate Resume

  • Establish and oversee the entire Payer Relations function including the development of work and staffing
  • Use sound judgment in making decisions and solving problems
  • Computer applications including database program, spreadsheets, and word processing
  • Ensure implementation of training and education programs for external providers
  • Communicate with NET vendors regarding contract compliance
  • Complete all credentialing activities as required for NET providers, ensure all requirements are met
  • Serve as point of contact for customers/providers regarding NET provider complaints.
  • Assist in evaluating future plans of and for the organization

Responsibilities For Provider Relations Consultant Resume

  • Coordinate training needs of providers
  • Meet with NET Providers on a regular basis to ensure understanding of requirements and service levels
  • Provide oversight for claim denial rates to identify and implement opportunities for training
  • Maintain process workflows including the provider complaint, communication and termination processes
  • Assists in the development and implementation of policies and procedures, internal workflows and other tools for staff training and compliance
  • Supports development and participates in presentations to existing and prospective providers and/or clients
  • Monitor scheduling key performance indicators
  • Lead system efforts focused on increasing provider loyalty and engagement through professional development and communication initiatives

Responsibilities For Provider Relations & Contracting Manager Resume

  • Decision-making process. Ability to handle most unique situations
  • Serves as contact for UPMC Health Plan commercial, Medicare and CHIP issues, including network expansion activities
  • General knowledge of best practices in health and human services, emphasizing work with special needs populations and in public sector systems
  • General knowledge of managed care functional areas, including terms and definitions
  • Monitors and supports providers using analytics available to improve performance
  • Collaborates with SLCN Account Manager in making presentations to employer groups
  • Supports SLCN clinical teams in troubleshooting network challenges
  • Provide on-site services to Contracted Physicians on an on-going basis
  • Responsible for overseeing the publication of the provider newsletters semi-annually

Responsibilities For Coord Provider Relations Resume

  • Maintain the data and integrity of the Contracting database
  • Assist with network marketing, employer and payor relations and product development
  • Perform facility site surveys as needed per credentialing requirements or state guidelines
  • Prepares documentation for meetings, schedules meetings, visit PCP/specialist officers for relationship building and performance insight
  • Educates providers regarding member benefits and referral process
  • Outbound contracting campaigns
  • Interrelate with various personnel, medical staff, management, departments, facilities, and agencies both verbally and in writing
  • Always exemplify exceptional customer service to providers’ offices, exhibiting professionalism at all times
  • Triage incoming inquiries from the Provider Relations line

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