Provider Relations Representative, Sr. jobs in Salem, 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)
Recently Added Provider Relations Representative, Sr. jobs
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 relationships so that the company becomes their plan of choice. Serves as the primary liaison between the company (“Plan”) and key provider organizations, taking the lead and promoting collaboration within the Plan, as it relates to provider network maintenance.
Manages territory inclusive of one or more of the 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.
Benefits:
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 Supervisors 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 agreements 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 about 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 a 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.
- BA/BS required or related field, or an equivalent combination of education, training, and experience.
- 4 or more year’s progressively responsible experience in provider relations or network management is required.
- Experience in the Medicare provider healthcare insurance industry preferred.
- Must have a valid driver’s license and access to reliable transportation.
- Knowledge or familiarity with Medicaid and Medicare is 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 a 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.
- Must be willing to travel significantly to local communities to meet business needs up to 50% of the time.
- Ability to work in a fast-paced environment.
- 7 Days Ago
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 outreachWorks collaboratively with Provi...
- 1 Month Ago
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 ...
- 13 Days Ago
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...
- 25 Days Ago
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 ...
- 19 Days Ago
Client Relations Representative - Remote Work
- BairesDev
-
Boston, MA
FULL_TIME
- We are looking for a Client Relations Representative with proven experience and a passion for selling technology solutions, to join our Sales Team and help spearhead our growth.
- 9 Days Ago
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0 Provider Relations Representative, Sr. jobs found in Salem, MA area
Customer Service Representative
- Walmart
-
Melrose, MA
- **Job Title: Customer Service Representative (Walmart)** **Job Summary:** As a Customer Service Representative at Walmar...
- 4/19/2024 12:00:00 AM
Client Service Representative
- Ultimate Staffing
-
Lawrence, MA
- We are seeking a dedicated and proactive individual to join our client's team as a Client Service Representative. The id...
- 4/19/2024 12:00:00 AM
Director of Behavioral Support Services (BCBA Required) - Department 980
- Bridgewell
-
Peabody, MA
- Bridgewell strengthens communities by providing an unmatched range of social and human services that empower people with...
- 4/18/2024 12:00:00 AM
Customer Service Representative (Call Center) START ASAP!!! $25/26/HR
- BlackTree Technical Group, Inc.
-
Danvers, MA
- Job Description Job Description Customer Service Representative (Call Center) START ASAP!!! $25/26/HR ESSENTIAL DUTIES A...
- 4/18/2024 12:00:00 AM
Customer Service Representative
- Jaguar Graphics, Inc
-
Danvers, MA
- Job Description Job Description Jaguar Graphics is a full service commercial printer celebrating it's 25th year on the N...
- 4/17/2024 12:00:00 AM
Sales Development Representative
- Moxie Management
-
Boston, MA
- Job Description Job Description Moxie Management is a local sales and consulting firm in Worcester. Recognized for our t...
- 4/17/2024 12:00:00 AM
Patient Services Representative Bi-Lingual
- North Shore Community Health
-
Salem, MA
- Apply Job Type Full-time Description Opportunity Overview North Shore Community Health (NSCH) is an industry leader in e...
- 4/16/2024 12:00:00 AM
Service Associate II (Wakefield)
- Eastern Bank
-
Wakefield, MA
- Service Associates are skilled in the duties of both a Customer Service Representative (sales on the platform), and Tell...
- 4/16/2024 12:00:00 AM
About Salem, Massachusetts
Salem is located at 42°31′1″N 70°53′55″W / 42.51694°N 70.89861°W / 42.51694; -70.89861 (42.516845, -70.898503). According to the United States Census Bureau, the city has a total area of 18.1 square miles (47 km2), of which 8.1 square miles (21 km2) is land and 9.9 square miles (26 km2), or 55.09%, is water. Salem lies on Massachusetts Bay between Salem Harbor, which divides the city from much of neighboring Marblehead to the southeast, and Beverly Harbor, which divides the city from Beverly along with the Danvers River, which feeds into the harbor. Between the two harbors lies Salem Neck a...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$80,034 to $99,252
Salem, Massachusetts area prices
were up 2.5% from a year ago
were up 2.5% from a year ago
What does a Provider Relations Representative, Sr. do?
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.
February 16, 2020
Provides telephonic provider education to new providers.
February 14, 2020
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