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:
Full-time remote work
Competitive salaries
Excellent benefits
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.
Strong follow-up skills.
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.