Provider Relations Representative, Sr. jobs in Somerville, 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
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 in order to enhance these relationships so that our health plan becomes their plan of choice.
- Serves as the primary liaison between the company and key provider organizations, taking the lead and promoting collaboration 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.
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. Documents all pertinent provider communications and meetings in Onyx
- 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. Monitors contractual compliance on an on-going basis
- 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
- 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 required
- Must have valid driver’s license and access to reliable transportation-must live in Massachusetts.
- Experience in the Medicare provider healthcare insurance industry required
- Understanding of the local provider community
- Familiarity with FACETS helpful
- 19 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...
- 1 Month 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 ...
- 25 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.
- 16 Days Ago
Associate Client Relations Representative - Parametric
- Morgan Stanley
-
Boston, MA
FULL_TIME
- ABOUT MORGAN STANLEYMorgan Stanley is a leading global financial services firm providing a wide range of investment banking, securities, wealth management and investment management services. With offi...
- 12 Days Ago
Provider Relations Consultant (Boston/Northeast MA) - $5000 sign on bonus!
- WellSense Health Plan
-
Boston, MA
FULL_TIME
- **We are offering a guaranteed $5000 sign on bonus for any person who is hired for this role!** It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company wit...
- 27 Days Ago
Filters
- Current Active Filter
- Somerville, MA
Clear All
- Filter Jobs By posted time
- Within 1 Day
- Within 2-7
- Within 1 Month
- Within 3 Months
0 Provider Relations Representative, Sr. jobs found in Somerville, MA area
Public Relations Representative
- Polarson, Inc.
-
Boston, MA
- About the Organization Polarson Inc., located in Lima, Ohio, is a manufacturing company that not only designs, but also ...
- 4/26/2024 12:00:00 AM
FT Customer Service Representative - Work From Home>
- ARIVE
-
Medford, MA
- [Call Center / Remote] Anywhere in U.S. / Up to $50K per year / Medical, Dental and Vision / 401k match / PTO - As a Cus...
- 4/25/2024 12:00:00 AM
FT Customer Service Representative - Work From Home>
- ARIVE
-
Everett, MA
- [Call Center / Remote] Anywhere in U.S. / Up to $50K per year / Medical, Dental and Vision / 401k match / PTO - As a Cus...
- 4/25/2024 12:00:00 AM
Valet Attendant (Part Time) Encore Boston Harbor
- Massachusetts Gaming Commission
-
Everett, MA
- Location: Location: Valet Attendant (Part Time) Encore Boston Harbor in Everett, MA at Encore Boston Harbor **Location:*...
- 4/25/2024 12:00:00 AM
Customer Service Representative
- Walmart
-
Cambridge, MA
- **Job Title: Customer Service Representative (Walmart)** **Job Summary:** As a Customer Service Representative at Walmar...
- 4/24/2024 12:00:00 AM
Customer Support Representative
- Morph Management
-
Boston, MA
- At Morph Management we specialize in taking our clients' product inquiries and turning them into profitable accounts. Th...
- 4/24/2024 12:00:00 AM
Customer Service Representative
- Walmart
-
Everett, MA
- **Job Title: Customer Service Representative (Walmart)** **Job Summary:** As a Customer Service Representative at Walmar...
- 4/24/2024 12:00:00 AM
Member Services Representative
- Planet Fitness Inc.
-
Cambridge, MA
- * In order to be considered as a candidate for this position, it is required you complete the 2nd step application. Upon...
- 4/22/2024 12:00:00 AM
About Somerville, Massachusetts
According to the United States Census Bureau, Somerville has a total area of 4.2 square miles (11 km2), of which 4.1 square miles (11 km2) is land and 0.1 square miles (0.26 km2) (2.61%) is water. Somerville is bordered by the cities of Cambridge, Medford, Everett, Arlington and the Boston neighborhood of Charlestown. It is located on the west bank of the Mystic River.
Millennia ago, glaciation left a series of drumlins running west to east across the landscape of what would become Somerville. These ridges would later become known as the "Seven Hills" of Somerville (like many other cities clai...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$80,177 to $99,430
Somerville, 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