Provider Relationship Account Consultant

Location: MA-Woburn, MA-Boston

Job Description Summary:

Responsible for providing quality, accessible and comprehensive service to the company's provider community.

How you will make an impact:

Develops and maintains positive provider relationships with provider community via a mixture of email, telephonic and/or face-to-face outreach, by communicating administrative and programmatic changes, facilitating provider education and the resolution of provider issues.
Collaborates with internal matrix partners to triage issues and submit work requests.
Generally assigned to a portfolio of providers within a defined cohort.
Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners.
Coordinates communication process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns.
Conducts routine outreach to support the understanding of managed care policies and procedures, as well as outreach on a variety of initiatives and programs.
Coordinates and conducts provider training including developing and distributing provider relations materials.
May assist with Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education and non-routine claim issues.
May coordinate Provider Manual updates/maintenance.
Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery.
Research issues that may impact future provider contract negotiations or jeopardize network retention.
Minimum Requirements:
Requires a bachelor's degree; a minimum of 2 years of customer service experience including 1 year of experience in a healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background. Travels to worksite and other locations as necessary.

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