Provider Relations Specialist Resume Sample

Updated July 21, 2021
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An interview is the most important stage in the job application process but in order to reach it, you have to step on the first stepping stone – the resume.

This particular stage is where the whole job application process begins. And this is where it needs to be the “best”. 

Take a look at a resume sample of a provider relations representative position as an example:

Sample Resume for Provider Relations Job

Paul Young
1850 Clark Road
Tilton, NH 88987
(000) 999-1452 
paulyoung @ email . com


 PROVIDER RELATIONS SPECIALIST

Performance Summary
 Enthusiastic provider relations specialist with 15 years’ extensive experience in building and maintaining relationships with users and providers, aimed at providing a high level of customer service. Effectively able to review claims documents and handle payment recoveries. Documented success in:
• Efficiently and accurately managing provider demographic information such as tax identification numbers and new addresses.
• Handling expansion of mails, tracking spreadsheets, and managing auditing and tracking duties.
• Investigating and resolving member complaints regarding providers to ensure satisfaction at both levels.
• Proactively identifying provider needs and advising management of ways to address their needs.

AREAS OF EXPERTISE
• Complaints Investigation
• Resolution Facilitation
• Deficiency Identification
• Access and Availability
• Incentive Programs Facilitation
• Membership Growth and Retention
• Compliance Assurance 

PROFESSIONAL EXPERIENCE

CHS SERVICES, Tilton, NH 
July 2011- Present
Provider Relations Representative
• Foster strong, positive relationships with all 50 providers on the panel, making it easy for the organization to handle problems
• Investigate a provider problem resulting in increased customer satisfaction.
• Build positive relationships between health plans, providers, and practice managers.
• Identify and remediate claims to ensure early resolution of claims problems.
• Assist providers in setting up and utilizing provider portals and networks.
• Answer and service departmental telephone calls and provide exceptional services to callers.
• Create and maintain provider contract files in a safe and confidential manner.
• Assume lead for special projects by assisting with mail expansions and tracking spreadsheets.
• Assist with a full range of provider relations and service interactions such as an end to end provider claim and call quality training.
• Provide support by handling queries regarding claim statuses of medical and dental nature.

AVESIS INCORPORATED, Tilton, NH
May 2006 – July 2011
Provider Relations Specialist
• Proactively identified provider needs and advised on various methods of meeting those needs, resulting in process improvement.
• Identified a network deficiency, which if left unaddressed would have created a huge loophole in both service and provider relations.
• Took telephone calls and provided information regarding statuses of claims.
• Assisted in investigating and resolving member complaints regarding providers.
• Provided support in establishing and fostering strong relationships with all members.
• Educated providers on incentive programs and facilitated retrieval of member healthcare records.
• Assisted with credentialing audits and on-site provider assessments.

EDUCATION
NEW HAMPSHIRE STATE UNIVERSITY, Tilton, NH – 2005
Bachelor’s Degree in Health Care Administration