*** 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