Sr Provider Relations Consultant SpringfieldWestern MA

Well Sense Health Plan
US - Massachusetts - Charlestown
January 7, 2025

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
• 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 Well Sense Health Plan becomes their plan of choice. Serves as the primary liaison between Well Sense Health Plan ("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:
Full-time 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 pre-set 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 year's 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 driver's 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

About WellSense
WellSense Health Plan 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, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

Read the full job description and apply online on the recuiter's web-site

Sr Provider Relations Consultant SpringfieldWestern MA

Sr Provider Relations Consultant SpringfieldWestern MA

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