Sr Provider Relations Consultant

Veracity Software Inc; Boston (MA); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading company in healthcare is seeking a Sr Provider Relations Consultant based in Massachusetts. This role involves developing relationships with healthcare providers and requires significant travel within the state. The ideal candidate will have experience in provider relations, strong communication skills, and a background in the healthcare industry.

Benefits

Full-time remote work

Competitive salaries

Excellent benefits

Qualifications

• 4+ years in provider relations or network management.
• Medicare experience preferred.

Responsibilities

• Develops and enhances relationships with providers.
• Coaches and trains Provider Relations staff.
• Analyzes operational issues and provider data.

Skills

Effective communication

Relationship-building

Analytical skills

Organizational skills

Familiarity with Medicaid

Familiarity with Medicare

Education

BA/BS or related field

Tools

Microsoft Office

Excel

Access

FACETS

Job description

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Sr Provider Relations Consultant

Boston, MA 02109

Remote – Local Only - they must be able to service a general area

Travel: Up to 60% of the time

Must-Haves

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

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Develops and enhances relationships with physicians, clinicians, community health centers, and hospitals through effective business interactions and outreach.
• Collaborates with Provider Relations team to develop and update provider orientation programs.
• Coaches and trains Provider Relations staff.
• Organizes and conducts provider orientations.
• Leads specific initiatives related to provider education.
• Provides support on BMCHP products and policies, and coordinates meetings with providers.
• Maintains regular contact with assigned providers.
• Acts as liaison for reimbursement, credentialing, claims, and EDI issues.
• Resolves complex contractual and provider issues collaboratively.
• Works with Contract Managers to ensure contractual compliance.
• Manages information flow to and from provider offices.
• Monitors market trends and issues.
• Performs outreach based on Plan initiatives.
• Analyzes operational issues and provider data.
• Facilitates problem resolution and interdepartmental collaboration.
• Identifies system updates and researches provider data.
• Represents Provider Relations at external events.
• Supports provider education, credentialing, and recruitment reports.
• Assists with marketing materials and community outreach.
• Ensures compliance with Medicaid and NCQA regulations.

Education:

BA/BS or related field, or equivalent experience.

Experience:

4+ years in provider relations or network management; Medicare experience preferred.

Certifications:

Valid driver’s license and reliable transportation required.

Skills & Attributes:

• Familiarity with Medicaid and Medicare.
• Understanding of the local provider community.
• Effective communication and relationship-building skills.
• Strong analytical and organizational skills.
• Proficiency with Microsoft Office, especially Excel and Access; FACETS familiarity helpful.

Working Conditions:

Significant travel in local communities, up to 50% of time, and ability to work in a fast-paced environment.