Sr Provider Relations Consultant - Boston, United States - 77 Consultants

Description

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
Requirements

Must-Haves
Be a resident of Massachusetts.
Previous work with MA Provider Relations
Ability to travel to provider offices and hospitals in MA 50% of the time (remainder is work from home.)
Valid drivers license
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 years 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 drivers license and access to reliable transportation

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