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Senior Provider Relations Consultant

Boston, MA · Healthcare
*** There is a guaranteed $1000 sign on bonus for this role, paid after 90 days on the job*****
  • Responsible for managing assigned territory of professional, institutional and ancillary provider types in order to enhance these relationships so that our health plan becomes their plan of choice.
  • Serves as the primary liaison between the company and key provider organizations, taking the lead and promoting collaboration 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.

  • 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 pre-set site visit servicing standards. Documents all pertinent provider communications and meetings in Onyx
  • 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. Monitors contractual compliance on an on-going basis
  • 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
  • BA/BS required or  related field, or an equivalent combination of education, training and experience
  • 4 or more year’s progressively responsible experience in provider relations or network management required
  • Must have valid driver’s license and access to reliable transportation-must live in Massachusetts.
  • Experience in the Medicare provider healthcare insurance industry required
  • Understanding of the local provider community
  • Familiarity with FACETS helpful

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