Job Title: Senior Provider Relations Consultant
Location: Boston MA USA
Max Salary - $90,500 $1000 SIGN ON BONUS
Note: Applicant must be resident of the USA or Green Card Holder.
Must-Haves
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
Interview Steps