Sr Provider Relations Consultant

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 pre-set 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

Must-Haves

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 license
5. Previous healthcare industry experience

Qualifications:

Education:

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

Experience:

• 4 or more year’s 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 driver’s license and access to reliable transportation

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