Provider Relations Consultant
Acts as the primary operational contact between BMCHP ( Plan ) and key provider organizations, taking the lead and promoting collaboration within Plan, as it relates to provider network maintenance. Manages territory inclusive of strategic network partnerships, as well as multiple other providers, facilities and community health centers. Works closely with the Provider Relations Manager to identify issues and report trends. Acts as liaison between provider and internal Plan departments such as Claims, Audit, Marketing, Member and Provider Enrollment and Health Services.
* Develops and enhances our physician, clinician, community health center and hospital relationships through effective business interactions and outreach
* Organizes, prepares and conducts orientations of key network providers 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 administrative meetings.
* Meets with assigned providers regularly according to 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
* Provides general education and support on BMCHP products, policies, procedures and operational issues.
* 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 the implementation of new provider contracts, assisting when needed, so providers can be credentialed, loaded in systems and notified within standards set by department.
* 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 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.
* 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 MassHealth, The Connector and NCQA.
* Other responsibilities as assigned.
* Regular and reliable attendance is an essential function of the position.
* Indirect supervision is received weekly.
* Bachelor s degree in Business Administration, related field or an equivalent combination of education, training and experience is required.
* 2 or more years of progressively responsible experience in a managed care or healthcare environment is preferred.
* Experience in the Medicare provider healthcare insurance industry
Certification or Conditions of Employment:
* Pre-employment background check
* Must have valid drivers license and access to a car
Competencies, Skills, and Attributes:
* Ability to work as a team member, to manage multiple tasks, to be flexible, and to work independently and possess excellent organizational skills.
* Proven expertise utilizing Microsoft Office products.
* Effective communication skills (verbal and written).
* Strong follow-up skills
* Proficient in multi-tasking
* Ability to set and manage priorities
Working Conditions and Physical Effort:
* Travel up to 75%
*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status