Sr Provider Relation....
Sr Provider Relations Consultant-BostonMA
Posted on :
16-02-2024
Employer Active
1 Vacancy
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
16-02-2024
Job Description
Req ID : 2561146
MustHaves
1 Be a resident of Massachusetts.
2 Previous work with MA Provider Relations
3 Ability to travel to provider offices and hospitals in MA 50% of the time (remainder is work from home.)
4 Valid drivers liscense
5 Previous healthcare industry experience
1 Be a resident of Massachusetts.
2 Previous work with MA Provider Relations
3 Ability to travel to provider offices and hospitals in MA 50% of the time (remainder is work from home.)
4 Valid drivers liscense
5 Previous healthcare industry experience
Job Description
Its an exciting time to join our client a growing regional health insurance company with a 25year history of providing health insurance that works for our members no matter their circumstances.
Responsible for managing assigned territory of professional institutional and ancillary provider types in order to enhance these relationships so that our client becomes their plan of choice. Serves as the primary liaison between our client and key provider organizations taking the lead and promoting collaboration within Plan as it relates to provider network maintenance. Manages territory inclusive of one or more of highest priority network partnerships as well as multiple other providers facilities and community health centers. Works closely with the Provider Relations Supervisor to identify issues and report trends. Acts as liaison between provider and internal Plan departments such as Provider Enrollment Claims Audit Marketing Customer Care and Care Management.
Our Investment in You:
Fulltime remote work
Competitive salaries
Excellent benefits
Competitive salaries
Excellent benefits
Key Functions/Responsibilities:
- Develops and enhances our physician clinician community health center and hospital relationships through effective business interactions and outreach
- Works collaboratively with Provider Relations Consultants and Supervisor to develop and update provider orientation programs
- Coaches and assists in the training of Provider Relations Consultants and Provider Relations Specialists
- Organizes prepares and conducts orientations of network providers (administrative and clinical) and their staff
- Takes the lead on specific Plan initiatives as they relate to provider education
- Provides general instruction and support on BMCHP products and policies to providers and coordinates office and provider site clinical and administrative meetings
- Meets with assigned providers regularly according to preset site visit servicing standards
- Acts as liaison for all reimbursement credentialing claims EDI web site procedures and issues of key providers
- Facilitates resolution of complex contractual and member/provider issues collaborating with internal departments as necessary
- Works collaboratively with Contract Managers in implementing and administering contractual provisions of provider agreement to ensure contractual compliance
- Manages flow of information to and from provider offices
- Monitors and communicates market trends and issues
- Outreaches to providers according to Plan initiatives
- Analyzes operational issues with regard to territory and provider operations such that interrelationships among other area providers are considered
- Facilitates timely problem resolution
- Initiates Plan interdepartmental collaboration to resolve complex provider issues
- Identifies system updates needed and completes research related to provider data in Onyx and Facets
- Represents Provider Relations and the plan at external provider and community events to maintain visible presence
- Processes reports as needed to support provider education servicing credentialing and recruitment
- Assists in developing marketing materials
- Participates in community outreach activities and events
- Ensures quality and compliance with state Medicaid regulations and NCQA requirements
- Other responsibilities as assigned
Qualifications:
Education:
BA/BS required or related field or an equivalent combination of education training and experience
Experience:
- 4 or more years progressively responsible experience in provider relations or network management required
- Experience in the Medicare provider healthcare insurance industry preferred
Certification or Conditions of Employment:
- Must have valid drivers license and access to reliable transportation
- Competencies Skills and Attributes:
- Knowledge or familiarity with Medicaid and Medicare required
- Understanding of the local provider community
- Proven demonstration of effective communication skills (verbal and written) and interpersonal skills
- Demonstrated ability to establish build and maintain relationships with internal and external constituents
- Strong analytical research and organizational skills
Strong follow up skills
- Ability to think and react quickly to address questions and issues while interacting with the provider community
- Foster an atmosphere of collaboration and teamwork internally and externally
- Demonstrate initiative judgment discretion and ability to operate within politically sensitive framework
- Ability to be flexible work independently and manage multiple tasks
- Demonstrated competence using Microsoft Office products especially Excel and Access; familiarity with FACETS helpful
Working Conditions and Physical Effort:
- Must be willing to travel significantly to local communities to meet business needs up to 50% of time
- Ability to work in a fast paced environment
Employment Type
Full Time
Key Skills
- Revenue Cycle Management
- Marketing
- Public Relations
- Algebra
- MailChimp
- Media Relations
- Social Listening
- Relationship Management
- Customer relationship management
- Medicare
- Public Speaking
- Writing Skills
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