Sr Provider Relations Consultant

Job Description

This is an exciting time to join a growing regional health insurance company with a history of providing health insurance that works for members no matter their circumstances. The role involves managing an assigned territory of professional, institutional, and ancillary provider types to enhance relationships, making the health plan the plan of choice. Serves as the primary liaison between the health plan and key provider organizations, promoting collaboration within the plan related to provider network maintenance. The role includes working closely with the Provider Relations Supervisor to identify issues and report trends, acting as a liaison between providers and internal departments, and facilitating problem resolution.

Investment in You

Full-time remote work(must be able to service a general area), competitive salaries, excellent benefits.

Key Functions/Responsibilities

• Develop and enhance relationships with physicians, clinicians, community health centers, and hospitals through effective business interactions and outreach.
• Organize, prepare, and conduct orientations for network providers, both administrative and clinical.
• Act as a liaison for all reimbursement, credentialing, and claims issues of key providers.
• Manage flow of information to and from provider offices, monitor and communicate market trends, and ensure quality and compliance with state Medicaid regulations and requirements.

Qualifications

Education: BA/BS required or related field, or an equivalent combination of education, training, and experience. Experience: 4 or more years of progressively responsible experience in provider relations or network management required. Experience in the Medicare provider healthcare insurance industry preferred. Must have a valid driver's license and access to reliable transportation.

Competencies, Skills, and Attributes

• Knowledge or familiarity with Medicaid and Medicare required.
• Strong analytical, research, and organizational skills.
• Ability to work independently and manage multiple tasks.

Working Conditions and Physical Effort

Must be willing to travel significantly to local communities to meet business needs, up to 60% of the time. Ability to work in a fast-paced environment.

Travel Required: Up to 60% of the time
Work Remotely: Yes, but must be able to service a general area
Visa Support: No visa sponsorships supported

Location

City: Boston, MA