Provider Relations Specialist

New Bedford, MA | Direct Hire

Post Date: 08/10/2017 Job ID: 79197 Specialty: Healthcare

We have an exciting opening as a Provider Relations Specialist at a managed health care organization in New Bedford, MA. In this role, you will act as the primary operational contact between the organization and key provider organizations, taking the lead and promoting collaboration, as it relates to provider network maintenance. This role also include 75% of travel. Don’ t miss this wonderful opportunity to join a dynamic and rapidly growing company!

Responsibilities for the Provider Relations Specialist:
  • Develop and enhance physician, clinician, community health center and hospital relationships
  • Organize, prepare and conduct orientations of key network providers and their staff
  • Meet with assigned providers and document all pertinent provider communications and meetings in Onyx
  • Act as liaison for all reimbursement, credentialing, claims, EDI web site procedures and issues of key providers
  • Provide general education and support on products, policies, procedures and operational issues
  • Work with Contract Managers in implementing and administering contractual provisions of provider agreements
  • Manage the implementation of new provider contracts
  • Manage flow of information to and from provider offices
  • Outreach to providers
  • Analyze operational issues
  • Facilitate problem resolution
  • Identify system updates and complete research related to provider data in Onyx and Facets
  • Process reports as needed to support provider education, servicing, credentialing and recruitment
  • Assist in developing marketing materials
  • Ensures quality and compliance with MassHealth, The Connector and NCQA
Requirements for the Provider Relations Specialist:
  • Bachelor’ s Degree in Business Administration, related field or an equivalent combination of education, training and experience
  • 2+ years of experience in a managed care or healthcare environment preferred

  • Must have valid driver’ s license and access to a car
  • Technology savvy with a strong knowledge working with Microsoft Office
  • Strong organizational skills with great attention to detail
  • Strong multi-tasking and prioritizing skills with the ability to meet deadlines
  • Excellent written and verbal communication skills
  • Strong interpersonal skills with a customer service focus
  • Ability to work independently and as part of a team
  • Must be eligible to work in the U.S. without sponsorship                      

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