Sr Provider Relations Consultant

• Be a resident of Massachusetts.
• Previous work with MA Provider Relations
• Ability to travel to provider offices and hospitals in MA 50% of the time (remainder is work from home.)
• Valid drivers license
• Previous healthcare industry experience

Job Description

• Fulltime remote work
• Competitive salaries
• Excellent benefits

• 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

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