Provider Relations Representative, Sr. jobs in Medford, MA

Provider Relations Representative, Sr. supports, develops and maintains service relationships with all participants (physicians, providers and administrators) of a provider network. Responds to electronic and direct inquiries from clients about policies, rates, changes, referrals, eligibility, credentialing, etc. May provide guidance or expertise to less experienced representatives. Being a Provider Relations Representative, Sr. typically requires a bachelor's degree. Typically reports to a supervisor or manager. The Provider Relations Representative, Sr. gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Relations Representative, Sr. typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

7
Sr Provider Relations Consultant
  • 77 Consultants
  • Boston, MA FULL_TIME
  • 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
    Requirements

    Must-Haves

    1. Be a resident of Massachusetts.
    2. Previous work with MA Provider Relations
    3. Ability to travel to provider offices and hospitals in MA 50% of the time (remainder is work from home.)
    4. Valid drivers license
    5. Previous healthcare industry experience
     

    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

  • 15 Days Ago

T
Sr. Provider Relations Consultant
  • Top Tier Reps LLC
  • Boston, MA FULL_TIME
  • Salary: $75,000 - $85,000 per year*** Guaranteed $5,000 sign-on bonus***Responsible for managing assigned territory of professional, institutional, and ancillary provider types to enhance these relati...
  • 16 Days Ago

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Senior Provider Relations Consultant
  • RennickBarrett Recruiting, INC
  • Boston, MA FULL_TIME
  • *** There is a guaranteed $1000 sign on bonus for this role, paid after 90 days on the job***** Responsible for managing assigned territory of professional, institutional and ancillary provider types ...
  • 18 Days Ago

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Sr. Employee Relations Officer
  • Boston College
  • Chestnut Hill, MA FULL_TIME
  • Boston College IntroductionFounded in 1863, Boston College is a Jesuit, Catholic university located six miles from downtown Boston with an enrollment of 9,484 full-time undergraduates and 5,250 gradua...
  • 2 Days Ago

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Patient Family Relations Representative
  • Massachusetts General Hospital
  • Boston, MA FULL_TIME
  • Description General Summary/ Overview: The Patient Family Relations Representative is responsible for being the first impression and "front door" of the office, which includes answering a high volume ...
  • 6 Days Ago

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Sr. Client Relations Specialist - Fund Event Team
  • DST Retirement Solutions, LLC
  • Quincy, MA FULL_TIME
  • SS&C is a global provider of investment and financial services and software for the financial services and healthcare industries. Named to Fortune 1000 list as top U.S. company based on revenue, SS&C ...
  • 2 Months Ago

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0 Provider Relations Representative, Sr. jobs found in Medford, MA area

M
Customer Support Representative
  • Morph Management
  • Somerville, MA
  • At Morph Management we specialize in taking our clients' product inquiries and turning them into profitable accounts. Th...
  • 3/28/2024 12:00:00 AM

A
Customer Service Professional (Remote)
  • AllWays Health Partners
  • Somerville, MA
  • Job Description - Customer Service Professional (Remote) (3179623) **Job Description** Customer Service Professional (Re...
  • 3/28/2024 12:00:00 AM

C
Member Service Representative, Naveo Credit Union, Somerville, MA
  • Cooperative Credit Union Association
  • Somerville, MA
  • **Member Services Sales and Service Rep, Metro Credit Union, Chelsea, MA** Join a fast-paced, dynamic, growing team and ...
  • 3/28/2024 12:00:00 AM

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Associate Counsel-Labor
  • UMass President's Office
  • Boston, MA
  • Primary Work Location: Amherst, Westborough or Boston, Massachusetts Job Summary: Labor and Employment attorney position...
  • 3/27/2024 12:00:00 AM

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Assistant Director of Employer Relations - Career Services
  • Tufts University
  • Medford, MA
  • Overview The Tufts Career Center provides comprehensive career development assistance to undergraduates, graduate studen...
  • 3/27/2024 12:00:00 AM

M
Customer Service Rep.
  • Massachusetts General Hospital
  • Somerville, MA
  • Job Description Customer Service Rep. - ( 3163811 ) **Description** **General Summary :** **Under the general direction ...
  • 3/27/2024 12:00:00 AM

B
Client Relations Representative - Logistics Coordinator
  • Barrett Tree Service East, Inc
  • Medford, MA
  • Job Description Job Description Barrett Tree Services East is a TCIA-accredited premiere tree care company based in Medf...
  • 3/26/2024 12:00:00 AM

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FT Customer Service Representative - Work From Home>
  • Dick's Sporting Goods, Inc.
  • Somerville, MA
  • [Customer Support / Remote] - Anywhere in U.S. / Up to $46.2K per year / Benefits - As a Customer Service Rep you'll: As...
  • 3/25/2024 12:00:00 AM

Medford is a city 3.2 miles northwest of downtown Boston on the Mystic River in Middlesex County, Massachusetts, United States. In the 2010 U.S. Census, Medford's population was 56,173. It is home to Tufts University, which has its campus along the Medford and Somerville border. Medford is located at 42°25′12″N 71°6′29″W / 42.42000°N 71.10806°W / 42.42000; -71.10806 (42.419996, −71.107942). According to the United States Census Bureau, the city has a total area of 8.6 square miles (22 km2), of which, 8.1 square miles (21 km2) of it is land and 0.5 square miles (1.3 km2) of it (5.79%) is wat...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$80,397 to $99,703
Medford, Massachusetts area prices
were up 2.5% from a year ago

Provider Relations Representative, Sr. in Kingsport, TN
A job as a Provider Relations Representative falls under the broader career category of Business Operations Specialists, All Other.
February 18, 2020
Provider Relations Representative, Sr. in Sioux City, IA
The PR Rep serves as a liaison between contracted payers, providers and ancillary providers to promote superior customer service and seamless programs.
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Provides telephonic provider education to new providers.
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Provider Relations Representative, Sr. in Buffalo, NY
This position provides on-going communication, in-service, orientation, and direction to these contracted provider offices.
February 03, 2020