Provider Relations Representative

Writing a great provider relations representative resume is important because it is one of the first things a potential employer will see when they are considering you for a position. It is your opportunity to make a good first impression and sell yourself as the best candidate for the job.

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If you're looking for inspiration when it comes to drafting your own provider relations representative resume, look no further than the samples below. These resumes will help you highlight your experience and qualifications in the most effective way possible, giving you the best chance of landing the provider relations representative job you're after.

Resume samples

Georgianne Kapella

georgianne.kapella@gmail.com | (128) 839-7192 | Cedar Rapids, Iowa

Summary


I am a Provider Relations Representative with over 3 years of experience. I have worked extensively with provider networks and have developed strong relationships with providers. I understand the needs and concerns of both providers and payers, and am able to effectively advocate for both parties. I am skilled at problem-solving, negotiations, and conflict resolution. My goal is always to find the best solution that meets the needs of all involved parties

Experience


Provider Relations Representative at Blue Cross and Blue Shield of Iowa, IAJun 2022 - Present

  • Negotiated and created contracts with new providers, which resulted in an increase of provider network by 15%.
  • Developed positive relationships with providers through regular visits and communication, leading to a 10% decrease in complaints from providers.
  • Monitored provider performance against contracted terms and took appropriate action when necessary, resulting in improved quality of care for patients.
  • Investigated Provider claims issues and worked collaboratively with the Claims Department to resolve them timely, reducing claim payment turnaround time by 20%.
  • Assisted other departments within the company as needed with special projects related to provider relations/contracting.
  • Managed a caseload of 100+ active Providers while consistently meeting or exceeding all individualized quantitative goals set forth by management.

Provider Relations Representative II at UnitedHealthcare of the Midlands, Inc., IAAug 2019 - Apr 2022

  • Negotiated and created provider contracts resulting in an annual savings of $600,000.
  • Led training sessions for new Provider Relations Representatives which improved the quality of work by 30%.
  • Wrote proposals to various state governments which led to the approval of 5 new Medicaid plans.
  • Resolved over 500 provider complaints through effective communication and negotiation.
  • Monitored providers’ compliance with contract terms and conditions, identified issues, and took corrective action when necessary.
  • Maintained up-to-date knowledge of all relevant laws, regulations, policies, procedures.

Education


High School Diploma at Iowa City High School, Iowa City, IASep 2015 - May 2019

I've learned how to read, write, and do math.

Skills


  • Communication
  • Writing
  • Organizational
  • Computer skills
  • Negotiation
  • Persuasion
  • Research

Nyeshia Stilwell

nyeshia.stilwell@gmail.com | (822) 206-0101 | Iowa City, IA

Summary


I have over 3 years of experience as a Provider Relations Representative. I am responsible for maintaining relationships with providers, conducting provider training and orientations, monitoring provider performance metrics, and investigating and resolving provider complaints. I have excellent communication skills and thrive in fast-paced environments.

Experience


Provider Relations Representative at Blue Cross Blue Shield, IAMar 2022 - Present

  • Negotiated and executed provider contracts with physicians, clinics, hospitals, and ancillary providers which resulted in $2M in annual savings for the company.
  • Managed a portfolio of 100+ provider relationships, ensuring contract compliance and maximizing revenue opportunities.
  • Successfully implemented a new physician incentive program that increased patient satisfaction scores by 5%.
  • Led Provider Relations team in creating best practices manual to increase efficiency and effectiveness of department processes saving the company $50K annually.
  • Saved space for number 5 */.

Provider Relations Representative II at United Healthcare, IASep 2019 - Jan 2022

  • Negotiated and created contracts with new providers, resulting in an increase of network providers by 15%.
  • Monitored provider performance metrics and took appropriate actions to improve quality of care, leading to a 5% decrease in complaints from patients.
  • Led training sessions for new Provider Relations Representatives, which resulted in a 20% reduction in onboarding time for new hires.
  • Collaborated with other departments to resolve provider billing issues, saving the company $100,000 per month.
  • Wrote policies and procedures related to provider relations department operations, improving efficiency by 30%.

Education


High School Diploma at Ames High School, Ames, IASep 2014 - May 2019

I have learned time management, organization, study skills, and how to be an independent learner.

Skills


  • Communication
  • Customer Service
  • Interpersonal Skills
  • Organizational Skills
  • Writing Skills
  • Negotiation skills
  • Computer skills