Sr Provider Relations Consultant-Boston/MA -

Wiley Tech Recruiting Firm; Boston (MA); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

$5000 sign-on bonus

Job summary

A leading health insurance firm is looking for a Sr Provider Relations Consultant in Boston, MA. This role involves developing relationships with healthcare providers and requires a BA/BS degree. The ideal candidate will have 4+ years of related experience, including a preference for those with Medicare knowledge. Key responsibilities include resolving issues and leading education initiatives. The role offers a $5000 sign-on bonus. Travel is expected up to 50%.

Qualifications

• 4+ years of experience in provider relations or network management.
• Experience in Medicare provider healthcare insurance industry preferred.
• Valid driver's license and reliable transportation required.

Responsibilities

• Develop relationships with healthcare providers.
• Collaborate for effective business interactions.
• Lead provider education initiatives.
• Conduct provider orientations.
• Act as liaison between the Plan and providers.
• Manage territory and partnerships.
• Resolve contractual issues.

Skills

Effective communication skills

Analytical skills

Research skills

Organizational skills

Knowledge of Medicaid and Medicare

Ability to maintain relationships

Competence in Microsoft Office

Education

BA/BS or related field

Tools

Microsoft Excel

Microsoft Access

FACETS

Job description

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.