Job Title: Provider Relations Consultant
Location : Boston/Eastern MA USA
Max - $75,000
5k sign on bonus
Note: Applicant must be resident of the USA or Green Card Holder.
Must-Haves
- Previous Provider Relations Experience in Massachusetts
- Experience with Medicare and Medicaid reimbursement methodologies
- Must have valid driver’s license and access to a car- travel 50% of time in assigned territory
- Previous health insurance industry experience
- Live in the Massachusetts area
Job Description
**We are offering a guaranteed $5000 sign on bonus for any person who is hired for this role!**
It’s an exciting time to join our clients team, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
As a Provider Relations Consultant, you’ll act as the primary liaison between contracted medical providers and internal departments, such as Claims, Benefits, Audit, Member and Provider Enrollment and Clinical Services. In this role, you’ll identify and resolve multiple issues and work closely with the leadership team to problem-solve and report trends.
Our Investment in You
Competitive Salaries
Excellent Benefits
Position requires up to 50% local travel to our provider partners within the assigned region. Position will work from home when not traveling
Key Functions/Responsibilities:
- Investigate, document, track and assist with claims resolution.
- Interact with various operational departments to assure accurate and timely payment of claims in accordance with policies and procedures.
- Identify system changes impacting claims processing and work internally on resolution.
- Identify systematic issues and trends and research for potential configuration-related work.
- Analyze trends in claims processing and assist in identifying and quantifying issues.
- Run claim reports regularly to support external provider visits.
- Develop and enhance our physician, clinician, community health center and hospital relationships through effective business interactions and outreach,
- Act as liaison for all reimbursement issues with providers, including facilitating the resolution of complex contractual and member/provider issues while collaborating with internal departments as necessary.
- Provide general education and support on products, policies, procedures and operational issues as needed.
- Manage the flow of information between internal departments and providers to ensure timely communication full understanding regarding changes and updates.
- May outreach to providers according to initiatives.
- Facilitate interdepartmental collaboration to resolve complex provider issues.
- Identify system updates as needed and complete research related to provider data in Onyx and Facets.
- Process reports as needed to support provider education, servicing, credentialing and recruitment.
- Ensure quality and compliance with state agencies and NCQA.
- Other responsibilities as assigned.
- Ability to understanding of and implement relevant policies and procedures.
- Regular and reliable attendance is an essential function of the position.
Qualifications:
Education:
Bachelor’s degree in business administration or a related field or an equivalent combination of education, training and experience is required.
Experience:
- Two or more years of progressively responsible experience in a managed care or healthcare environment is preferred.
- Experience with Medicare and Medicaid reimbursement methodologies.
- Understanding of provider coding and billing practices.
- Certification or Conditions of Employment:
- Must have valid driver’s license and access to a car.
- Competencies, Skills and Attributes:
- Experience with ICD-10, CPT/HCPCS codes and billing claim forms
- Ability to work in a team environment, prioritize and manage multiple tasks, be flexible, and work independently
Excellent organizational skills
- Proven expertise utilizing Microsoft Office products
- Effective communication skills (verbal and written)
- Strong follow-up skills
Our client is a nonprofit health insurance company serving more than 440,000 members across Massachusetts and New Hampshire through Medicaid, Medicare, Individual and Family plans. Founded 25 years ago,