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Senior Provider Relations Consultant - Boston MA USA - $90,500 - $1000 SIGN ON BONUS

Note: Applicant must be resident of the USA or Green Card Holder.

Must-Haves

• BA/BS required or related field, or an equivalent combination of education, training and experience

• 4 or more years progressively responsible experience in provider relations or network management required
• Must have valid drivers 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

Nice-To-Haves

Familiarity with FACETS helpful

Job Description

*** 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 Well Sense Health Plan becomes their plan of choice. Serves as the primary liaison between Well Sense Health Plan (Plan) 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.

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

Screening Questions

• What prior experience do you have that will make you a great fit for this opportunity?
• Why are you looking to leave current role?
• Are you ok with traveling 50% of the time in this role?
• Are you familiar with forming and building provider relationships?

• What are your salary expectations?
• Are you in a agreeance with our COVID vaccination requirement?
• If we were to hire you, when would you be able to start?

Interview Steps

• Phone screen candidate
• Interview with hiring manager and supervisor
• additional team members screen

Benefits

• Dental
• Medical
• Vision
• Life
• Retirement

• Equity
• Paid time off