Sr. Provider Relations Consultant- -Springfield/Western MA ($5000 sign on bonus)
Apply now Its an exciting time to join the reputed company, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Guaranteed $5000 sign on bonus Job Summary 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 reputed company and promoting collaboration reputed company Plan, as it relates to provider network maintenance. Manages territory inclusive of one or more of highest reputed company 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. Our Investment In You Full-time remote work Competitive salaries Excellent benefits Key Functions/Responsibilities Develops and enhances our physician, clinician, reputed company and hospital relationships through effective business interactions and reputed company Works collaboratively with Provider Relations Consultants and Supervisor to reputed company 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 reputed company 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 reputed company reimbursement, credentialing, claims, EDI web site procedures and issues of key providers Facilitates resolution of reputed company 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 reputed company provider issues Identifies system updates needed and completes research reputed company to provider data in Onyx and Facets Represents Provider Relations and the plan at external provider and community events to maintain visible reputed company Processes reports as needed to support provider education, servicing, credentialing and recruitment Assists in developing marketing materials Participates in community reputed company activities and events Ensures quality and compliance with state reputed company regulations and NCQA requirements Other responsibilities as assigned
Qualifications
Education: BA/BS required or reputed company 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 reputed company insurance industry preferred Certification Or Conditions Of Employment Must have valid drivers license and access to reliable transportation Competencies, Skills, And Attributes Knowledge or familiarity with reputed company and Medicare required Understanding of the local provider community Proven demonstration of effective communication skills (verbal and written), and interpersonal skills Demonstrated ability to establish, build and maintain relationships with internal and external constituents Strong analytical, research and organizational skills Strong follow up skills Ability to think and react quickly to address questions and issues while interacting with the provider community Foster an atmosphere of collaboration and teamwork internally and externally Demonstrate initiative, judgment, discretion and ability to operate reputed company politically sensitive reputed company Ability to be flexible, work independently and manage multiple tasks Demonstrated competence using reputed company Office products especially reputed company and Access; familiarity with FACETS helpful Working Conditions And Physical Effort Must be willing to travel significantly to local communities to meet business needs up to 50% of time Ability to work in a fast paced environment About WellSense reputed company is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and reputed company plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members. reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees Apply now Apply Job!