Sr Provider Relations Consultant

Sr Provider Relations Consultant Boston, MA 02109 Remote - Local Only - they must be able to service a general area Travel: Up to 60% of the time Must-Haves Be a resident of Massachusetts. Previous work with MA Provider Relations Ability to travel to provider offices and hospitals in MA 50% of the time (remainder is work from home.) Valid drivers liscense Previous healthcare industry experience Our Investment in You: Full-time remote work Competitive salaries Excellent benefits Key Functions/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 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 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 Education: BA/BS required or related field, or an equivalent combination of education, training and experience Experience: 4 or more year's 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 valid driver's license and access to reliable transportation Competencies, Skills, and Attributes: Knowledge or familiarity with Medicaid and Medicare required Understanding of the local provider community Proven demonstration of effective communication skills (verbal and written), and interpersonal skills Demonstrated ability to establish, build and maintain relationships with internal and external constituents Strong analytical, research and organizational skills Strong follow up skills Ability to think and react quickly to address questions and issues while interacting with the provider community Foster an atmosphere of collaboration and teamwork internally and externally Demonstrate initiative, judgment, discretion and ability to operate within politically sensitive framework Ability to be flexible, work independently and manage multiple tasks Demonstrated 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 to meet business needs up to 50% of time Ability to work in a fast paced environment

Created: 2026-03-04