2009115 Provider Relations Specialist - Springfield, MA
Job Information
ID :
#10070515
# of Positions :
1
Experience Required :
2 years
License Required:
N/A
Training :
N/A
Duration :
Full Time Regular
Shift :
First Shift (Day)
Hours per week :
40
Job Description
A Provider Relations Specialist supports the external Provider Account Representatives by addressing issues that arise related to the daily network management of the interaction between a Provider and the Plan.
Key Functions & Responsibilities:
-Participates in the assembly, maintenance and preparation of materials for Provider orientations, site visits and recruitment in addition to letter of interest process.
-Takes minutes for key Provider site visits and JOC meetings, and distributes minutes to meeting participants.
-Assists in the scheduling of Provider Relations trainings and servicing meetings.
-Researches and facilitates interdepartmental issues related to reimbursement, claims, credentialing, and other network issues as identified by the External Provider Account Representatives.
-Acts as liaison for reimbursement, credentialing, claims, EDI website procedures and issues of key providers.
-Facilitates resolution of complex member/provider issues and collaborates with internal departments related to resolution.
-Collects and tracks Provider data, oversees compilation and maintenance of pertinent database information in Quickbase and Onyx.
-Conducts credentialing site visits as needed.
-Provides coverage for Proivder Relations Representatives in their absence.
-Processes activation/change forms and spreadsheets as needed
-Responsible for gathering and submitting data on non-par providers.
-Assists in creation and distribution of provider web logins.
-Manages distribution and research of returned mail.
-Manages the distribution and resolution of CRU tickets and claims workflow.
-Assists in ensuring completeness of information needed to complete contracting and credentialing processes.
-Manages creation and distribution of welcome letters and low priority recruitment mailings.
Education & Experience:
-High School Diploma or GED required.
-Associates degree in Business Administration or related field strongly preferred.
-2+ years business experience in a business or healthcare setting is required.
Competencies, Skills, & Attributes:
-Demonstrated competence using Microsoft Office products especially Word, Excel, Outlook, Access, PowerPoint.
-Experience or knowledge of FACETS or similar claims processing system.
-Effective communication skills (verbal and written).
-Ability to work as a team member.
-Must be able to manage multiple tasks and possess excellent organizational skills.
-Ability to be flexible and work independently.
Travel:
-Up to 25% local travel.
-Must have valid drivers license and access to a car.
Key Functions & Responsibilities:
-Participates in the assembly, maintenance and preparation of materials for Provider orientations, site visits and recruitment in addition to letter of interest process.
-Takes minutes for key Provider site visits and JOC meetings, and distributes minutes to meeting participants.
-Assists in the scheduling of Provider Relations trainings and servicing meetings.
-Researches and facilitates interdepartmental issues related to reimbursement, claims, credentialing, and other network issues as identified by the External Provider Account Representatives.
-Acts as liaison for reimbursement, credentialing, claims, EDI website procedures and issues of key providers.
-Facilitates resolution of complex member/provider issues and collaborates with internal departments related to resolution.
-Collects and tracks Provider data, oversees compilation and maintenance of pertinent database information in Quickbase and Onyx.
-Conducts credentialing site visits as needed.
-Provides coverage for Proivder Relations Representatives in their absence.
-Processes activation/change forms and spreadsheets as needed
-Responsible for gathering and submitting data on non-par providers.
-Assists in creation and distribution of provider web logins.
-Manages distribution and research of returned mail.
-Manages the distribution and resolution of CRU tickets and claims workflow.
-Assists in ensuring completeness of information needed to complete contracting and credentialing processes.
-Manages creation and distribution of welcome letters and low priority recruitment mailings.
Education & Experience:
-High School Diploma or GED required.
-Associates degree in Business Administration or related field strongly preferred.
-2+ years business experience in a business or healthcare setting is required.
Competencies, Skills, & Attributes:
-Demonstrated competence using Microsoft Office products especially Word, Excel, Outlook, Access, PowerPoint.
-Experience or knowledge of FACETS or similar claims processing system.
-Effective communication skills (verbal and written).
-Ability to work as a team member.
-Must be able to manage multiple tasks and possess excellent organizational skills.
-Ability to be flexible and work independently.
Travel:
-Up to 25% local travel.
-Must have valid drivers license and access to a car.
Company Information
Name :
Description :
Boston Medical Center (BMC) HealthNet Plan is a non-profit managed care organization providing coverage to MassHealth (Medicaid) and Commonwealth Care members. Founded in 1997 by Boston Medical Center, the Plan contracts with providers and hospital systems throughout Massachusetts to deliver care to our members.
Type :
Direct Employer
Address :
2 Copley Place, Suite 600
Boston, MA 02116
Boston, MA 02116
Application Information
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