It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
- Guaranteed $5000 sign on bonus
Responsible for managing assigned territory of professional, institutional and ancillary provider types in order to enhance these relationships so that Well Sense Health Plan becomes their plan of choice. Serves as the primary liaison between Well Sense Health Plan (“Plan”) and key provider organizations, taking the lead and promoting collaboration within Plan, 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.
Our Investment in You :
Full-time remote workCompetitive salariesExcellent benefitsKey Functions / Responsibilities :
Develops and enhances our physician, clinician, community health center and hospital relationships through effective business interactions and outreachWorks collaboratively with Provider Relations Consultants and Supervisor to develop and update provider orientation programsCoaches and assists in the training of Provider Relations Consultants and Provider Relations SpecialistsOrganizes, prepares and conducts orientations of network providers (administrative and clinical) and their staffTakes the lead on specific Plan initiatives as they relate to provider educationProvides general instruction and support on BMCHP products and policies to providers and coordinates office and provider site clinical and administrative meetingsMeets with assigned providers regularly according to pre-set site visit servicing standardsActs as liaison for all reimbursement, credentialing, claims, EDI web site procedures and issues of key providersFacilitates resolution of complex contractual and member / provider issues, collaborating with internal departments as necessaryWorks collaboratively with Contract Managers in implementing and administering contractual provisions of provider agreement to ensure contractual complianceManages flow of information to and from provider officesMonitors and communicates market trends and issuesOutreaches to providers according to Plan initiativesAnalyzes operational issues with regard to territory and provider operations such that interrelationships among other area providers are consideredFacilitates timely problem resolutionInitiates Plan interdepartmental collaboration to resolve complex provider issuesIdentifies system updates needed and completes research related to provider data in Onyx and FacetsRepresents Provider Relations and the plan at external provider and community events to maintain visible presenceProcesses reports as needed to support provider education, servicing, credentialing and recruitmentAssists in developing marketing materialsParticipates in community outreach activities and eventsEnsures quality and compliance with state Medicaid regulations and NCQA requirementsOther responsibilities as assignedQualifications : Education
BA / BS required or related field, or an equivalent combination of education, training and experienceExperience :
4 or more year’s progressively responsible experience in provider relations or network management requiredExperience in the Medicare provider healthcare insurance industry preferredCertification or Conditions of Employment :
Must have valid driver’s license and access to reliable transportationCompetencies, Skills, and Attributes :
Knowledge or familiarity with Medicaid and Medicare requiredUnderstanding of the local provider communityProven demonstration of effective communication skills (verbal and written), and interpersonal skillsDemonstrated ability to establish, build and maintain relationships with internal and external constituentsStrong analytical, research and organizational skillsStrong follow up skillsAbility to think and react quickly to address questions and issues while interacting with the provider communityFoster an atmosphere of collaboration and teamwork internally and externallyDemonstrate initiative, judgment, discretion and ability to operate within politically sensitive frameworkAbility to be flexible, work independently and manage multiple tasksDemonstrated competence using Microsoft Office products especially Excel and Access; familiarity with FACETS helpfulWorking Conditions and Physical Effort :
Must be willing to travel significantly to local communities to meet business needs up to 50% of timeAbility to work in a fast paced environmentAbout WellSense
WellSense Health Plan 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, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.
Required Skills
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