Sr Provider Relations Consultant-Boston​/MA

Sr Provider Relations Consultant-Boston/MA - About the job Sr Provider Relations Consultant-Boston/MA -

Must-Haves:

• Be a resident of Massachusetts.
• Previous experience in MA Provider Relations.
• Ability to travel to provider offices and hospitals in MA (50% travel, remainder work from home).
• Valid driver's license.
• Previous healthcare industry experience.

Job Description:

Join our client, a leading regional health insurance company with a 25-year history, as they expand their team. Enjoy a guaranteed $5000 sign-on bonus and contribute to the growth.

Our Investment in You:

Key Functions/Responsibilities:

• Develop and enhance relationships with physicians, clinicians, community health centers, and hospitals.
• Collaborate with Provider Relations Consultants and Supervisor for effective business interactions.
• Lead specific Plan initiatives related to provider education.
• Conduct provider orientations and training programs.
• Act as a liaison between the Plan and key provider organizations.
• Manage assigned territory and provider network partnerships.
• Resolve complex contractual and member/provider issues.
• Collaborate with internal departments for issue resolution.
• Monitor and communicate market trends and issues.
• Represent Provider Relations and the plan at external events.
• Participate in community outreach activities and events.
• Ensure quality and compliance with state Medicaid regulations and NCQA requirements.

Qualifications:

• Education:
  
  BA/BS required or related field, or equivalent combination of education 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.
• Certification or Conditions of Employment:
  Must have a valid drivers license and access to reliable transportation.

Competencies, Skills, and Attributes:

• Knowledge or familiarity with Medicaid and Medicare.
• Understanding of the local provider community.
• Effective communication skills (verbal and written).
• Strong analytical, research, and organizational skills.
• Ability to establish and maintain relationships with internal and external constituents.
• Ability to work independently and manage multiple tasks.
• Competence using Microsoft Office products, especially Excel and Access; familiarity with FACETS helpful.

Working Conditions and Physical Effort:

• Must be willing to travel significantly to local communities (up to 50% of the time).
• Ability to work in a fast-paced environment.

About Our Client:

Our client, is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, provides high-quality health plans and services that work for its members, regardless of their circumstances.