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.