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Provider Services Representative Jobs (NOW HIRING)

MJHS

Provider Services Representative

Manhattan, NY

$40K - $43K/yr

Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high ...

VIVA USA INC

Provider Services Representative

El Paso, TX · On-site +1

$32K - $43K/yr

Maintain accuracy of provider information in core internal and member facing systems. Requires frequent contact with our provider partners to confirm the accuracy of information provided with 95% or ...

RadNet

Provider Service Rep

Union, NJ

$60K - $75K/yr

When you join RadNet as a Provider Service Representative , you will be joining a dedicated team of ... Be responsible for identifying, prospecting and marketing contract imaging services to local IPA ...

RadNet

Provider Service Rep

Union, NJ · On-site

$60K - $75K/yr

When you join RadNet as a Provider Service Representative , you will be joining a dedicated team of ... Be responsible for identifying, prospecting and marketing contract imaging services to local IPA ...

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All JobsProvider Services Representative Jobs

Provider Services Representative information

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$29.5K

$48.3K

$78.5K

How much do provider services representative jobs pay per year?

As of Jul 7, 2026, the average yearly pay for provider services representative in the United States is $48,284.00, according to ZipRecruiter salary data. Most workers in this role earn between $37,000.00 and $57,000.00 per year, depending on experience, location, and employer.

What are Provider Services Representatives?

Provider Services Representatives are professionals who serve as the main point of contact between healthcare providers (such as doctors, hospitals, and clinics) and health insurance companies. They help resolve provider inquiries related to claims, benefits, eligibility, authorizations, and network participation. Their role ensures smooth communication and understanding between providers and insurers, ultimately helping patients receive the care they need. Provider Services Representatives may also assist with provider education and support efforts to improve provider satisfaction.

What is the difference between Provider Services Representative vs Customer Service Representative?

AspectProvider Services RepresentativeCustomer Service Representative
CredentialsHigh school diploma or equivalent; healthcare knowledge often preferredHigh school diploma or equivalent; general customer service skills
Work EnvironmentHealthcare offices, insurance companies, provider networksRetail, call centers, various industries
Employer & IndustryHealthcare, insurance providersVarious sectors including retail, telecom, finance
Common Search IntentUnderstanding healthcare provider support rolesGeneral customer support roles

The Provider Services Representative primarily works within healthcare and insurance settings, focusing on supporting healthcare providers and managing provider-related inquiries. In contrast, a Customer Service Representative handles a broader range of customer inquiries across multiple industries. While both roles require strong communication skills, Provider Services Representatives often need healthcare knowledge and familiarity with insurance processes, making their role more specialized within the healthcare industry.

What are some of the most common challenges faced by Provider Services Representatives, and how can they be managed effectively?

Provider Services Representatives often encounter challenges such as resolving complex provider inquiries, navigating frequent updates to healthcare policies, and balancing a high volume of calls or cases. Successful representatives manage these challenges by staying up-to-date with policy changes through regular training, leveraging internal resources for quick issue resolution, and developing strong communication skills to clearly explain procedures to providers. Building collaborative relationships with other departments, such as claims or credentialing teams, also helps streamline the resolution process and enhances overall service quality.

What are the key skills and qualifications needed to thrive as a Provider Services Representative, and why are they important?

To thrive as a Provider Services Representative, you need strong knowledge of healthcare policies, insurance processes, and customer service, often supported by a relevant associate degree or healthcare administration experience. Familiarity with claims processing systems, medical billing software, and CRM platforms is typically required. Excellent communication, problem-solving, and organizational skills help you manage provider inquiries and resolve issues efficiently. These skills ensure accurate information exchange, provider satisfaction, and smooth operations within healthcare organizations.
More about Provider Services Representative jobs
What cities are hiring for Provider Services Representative jobs? Cities with the most Provider Services Representative job openings:
Who are the top companies hiring for Provider Services Representative jobs? The top employers for Provider Services Representative jobs are:
What states have the most Provider Services Representative jobs? States with the most job openings for Provider Services Representative jobs include:
What job categories do people searching Provider Services Representative jobs look for? The top searched job categories for Provider Services Representative jobs are:
Provider Services Representative jobs near you
Infographic showing various Provider Services Representative job openings in the United States as of July 2026, with employment types broken down into 1% Locum Tenens, 2% As Needed, 75% Full Time, 16% Part Time, and 6% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $48,284 per year, or $23.2 per hour.

Provider Services Representative

Leon Health Plan

Doral, FL • On-site

Other

Posted 19 days ago

Job description

SUMMARY

The Provider Services Representative role is primarily responsible for receiving incoming calls from both in-network and out-of-network providers and assisting them with their inquiries. Additionally, in times of high-call volume, Provider Services Representatives will be expected to assist the Leon Health Member Services line with the handling of member calls.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Professionally handles a high volume of inbound complex calls originating from the Leon Health Provider Services line, and at times, from the Leon Health Member Services line.
  • Assists with the processing of inbound correspondence from providers received via physical mail, fax, or e-mail.
  • Assists providers with authorization, claims and payment inquiries, including, but not limited to, providing claim status, claims/authorization denial rationale, payment status, assistance with EOPs/RAs, billing information, provider portal access, etc.
  • Assists members with effectively using their health care coverage by, including, but not limited, providing Plan eligibility information, reviewing Plan rules, benefit inquiries, authorization and claims status, and addressing any complaints or issues the member is having in accessing healthcare.
  • Identifies provider complaints (disputes/appeals) and ensures the provider is either educated or their complaint is routed to the appropriate department for resolution.
  • Identifies member complaints (grievances/coverage requests/appeals) and ensures these requests are properly classified, addressed, and routed for further review and resolution if needed.
  • Contributes to meeting or exceeding Leon Health Provider Services call center metrics and goals.
  • Follows up with callers to provide response or resolution steps as needed.
  • Clearly documents incoming and outgoing call reasons and dispositions in the call center system.
  • Develops and maintains positive provider and member relations and coordinates with various functions within the company to ensure provider and member requests and inquiries are handled appropriately and in a timely manner.
  • Demonstrates courtesy and politeness to patients, visitors, callers and other employees.
  • Maintains open channels of communication with center administration and other company departments; Answers all inquiries in a professional and courteous manner.
  • Actively participates in both classroom and online training and other educational opportunities as required.
  • Actively participates in department and organizational meetings as requested.
  • Complies with the organization's policies and procedures and maintains confidentiality in accordance with state and federal laws.
  • Participates in special projects and performs other duties as assigned.

QUALIFICATIONS

  • Basic understanding and ability to apply Centers for Medicare and Medicaid (CMS) regulatory requirements and standard operating procedures.
  • Computer Skills:Proficient in Microsoft Word and Microsoft Excel
  • Ability to work a schedule of Monday - Friday, 8:00 a.m. to 5:00 p.m., with flexibility to work occasional overtime per business needs and occasionally work Saturdays and Sundays for on-site/off-site training and projects.

WORK EXPERIENCE

  • Minimum one (1) year of experience working in a call center in insurance managed care, preferably a Medicare HMO.
  • Minimum of 1+ years of experience working with customer relation management software and/or healthcare records management software

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