Senior Provider Relations Consultant - 5K SIGN ON BONUS

*** Guaranteed $5000 sign on bonus***

Responsible for managing assigned territory of professional institutional and ancillary provider types in order to enhance these relationships so that THE Plan becomes their plan of choice. Serves as the primary liaison between 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 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:

Fulltime remote work

Competitive salaries

Excellent benefits

Key Functions/Responsibilities:

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 Supervisor 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 BMCHP products and policies to providers and coordinates office and provider site clinical and administrative meetings

Meets with assigned providers regularly according to preset site visit servicing standards

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

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

Qualifications:

Education:

BA/BS required or related 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 healthcare 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 Medicaid 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 within politically sensitive framework

Ability to be flexible work independently and manage multiple tasks

Demonstrated 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 to meet business needs up to 50% of time

Ability to work in a fast paced environment

Remote Work :

No