Senior Provider Relations Consultant
This job is no longer active.
View similar jobs.
POST DATE 5/23/2020
END DATE 6/11/2020
BMC HealthNet Plan
JOB DESCRIPTIONSENIOR PROVIDER RELATIONS CONSULTANT
Responsible for managing assigned territory of professional, institutional and ancillary provider types in order to enhance these relationships so that BMCHP/WellSense Health plan becomes their plan of choice. Serves as the primary liaison between BMCHP/WellSense ( Plan ) and key provider organizations, taking the lead and promoting collaboration within Plan, as it relates to provider network maintenance. Manages territory inclusive of one or more of highest priority 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 Provider Enrollment, Claims, Audit, Marketing, Customer Care and Care Management.
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 Manager 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 Plan 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. 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.
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 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.
BA/BS required or related field, or an equivalent combination of education, training and experience
4 or more year s progressively responsible experience in provider relations or network management required.
Experience in the Medicare provider healthcare insurance industry
Certification or Conditions of Employment:
Pre-employment background check
Must haveaccess to reliable transportation.
Competencies, Skills, and Attributes:
Knowledge or familiarity with Medicaid and Medicare is a plus
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
Demonstrated competence using Microsoft Office products especially Excel and Access; familiarity with FACETS helpful
Demonstrated competence using Microsoft Office products especially Word, Excel, Outlook, Access, PowerPoint. Experience or knowledge of FACETS.
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
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. BMC HealthNet? Plan/Well? Sense Plan participates in the E-Verify Program to electronically verify the employment eligibility of newly hired employees.