Provider Relations Representative, Sr. jobs in Waltham, 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
- 20 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 ...
- 26 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...
- 13 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...
- 28 Days Ago
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0 Provider Relations Representative, Sr. jobs found in Waltham, 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
Remote Client Success Rev Cycle Manager
- Fresenius Medical Care
-
Waltham, MA
- PURPOSE AND SCOPE: The Manager, Revenue Cycle provides direction and oversight of all ongoing revenue cycle activities w...
- 4/26/2024 12:00:00 AM
Member Service Representative, Waltham, Part-time
- Digital Federal Credit Union
-
Waltham, MA
- ** Member Service Representative, Waltham, Part-time** **Job Category****:** Branch Services **Requisition Number****:**...
- 4/26/2024 12:00:00 AM
Customer Service Representative
- Boston Direct Inc.
-
Watertown, MA
- Job Description Job Description We are currently hiring entry level customer service and sales individuals with a custom...
- 4/24/2024 12:00:00 AM
Entry Level Customer Service Representative
- Moxie Management
-
Waltham, MA
- A thriving Customer Service and Sales firm, Moxie Management is a dynamic team that serves the Worcester community with ...
- 4/24/2024 12:00:00 AM
Customer Service Representative
- Walmart
-
Belmont, MA
- **Job Title: Customer Service Representative (Walmart)** **Job Summary:** As a Customer Service Representative at Walmar...
- 4/24/2024 12:00:00 AM
Patient Access Representative - MAPS Center for Women
- Beth Israel Lahey Health
-
Watertown, MA
- When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. Job Typ...
- 4/22/2024 12:00:00 AM
Digital Account Executive
- NESN LTD
-
Watertown, MA
- Job Description Job Description Reporting to the Local Sales Manager, the Digital Account Executive role requires a team...
- 4/22/2024 12:00:00 AM
About Waltham, Massachusetts
Waltham (/ˈwɔːlθæm/) is a city in Middlesex County, Massachusetts, United States, and was an early center for the labor movement as well as a major contributor to the American Industrial Revolution. The original home of the Boston Manufacturing Company, the city was a prototype for 19th century industrial city planning, spawning what became known as the Waltham-Lowell system of labor and production. The city is now a center for research and higher education, home to Brandeis University and Bentley University. The population was 60,636 at the census in 2010.
Waltham is commonly referred to as W...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$80,177 to $99,430
Waltham, 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