Provider Relations Representative - Mid-Missouri

Job Title: Provider Relations Representative - Mid-Missouri

Reports To: Provider Relations Network Manager 

FLSA Status: Exempt 

Grade Level: 24 

Last Updated: December 2024 

 

Position Summary: 

The primary responsibility of the Provider Relations Representative is expanding and enhancing the provider relations network in their assigned territory.  This position develops relationships with new providers, negotiates provider contracts and ensures ongoing connections with existing providers.  This includes educating providers on contractual obligations, new products and services, and policies and procedures. 

 

Responsibilities: 

Executes account management and services strategies to expand and retain the Provider network.  This work may include but is not limited to: 


* Developing ongoing relationships with Providers to ensure satisfaction, foster trust, and address any concerns or issues to enhance network retention; 



* Executing tailored strategies to effectively manage provider accounts, ensuring that they meet both the needs of the providers and the organization's objectives; 



* Assessing provider performance, ensuring adherence to contract terms, quality standards, and service levels, and provide support to optimize their participation and effectiveness; 



* Expanding the Provider network through ongoing relationship building and value sharing through in-person meetings, cold calling, networking and other lead generation strategies; 



* Conducting onsite dental reviews at Provider locations; 


* Maintaining network participation by providing support to providers and office managers to improve their understanding of all available benefit programs, processing polices and guidelines. 

Leads the negotiation and implementation of Provider contracts.

This work may include but is not limited to: 


* Leading discussions and fee negotiations to get providers contracted into PPPO/Premier or Premier Exclusive networks; 



* Collaborating with internal departments to ensure that contracts meet regulatory standards and organizational policies, while aligning with provider expectations; 



* Validating new provider contracts ensuring correct ES and NPF data, and addressing any discrepancies in a timely manner; 



* Gathering reporting to support the practice and provider fee increase discussions; 



* Implementing new provider contracts, ensuring all operational, billing, and technical requirements are addressed and systems are updated accordingly. 

Serves as trusted advisor to the Providers and their team members on industry trend and best practices.  This work includes but is not limited to: 


* Sharing information regarding current and future products and services; 



* Understanding internal processes and timelines to set expectations and recommend best practices; 



* Influencing Providers based on subject matter expertise of the industry, plan...