Sr. Provider Relations Consultant (Springfield, MA)

Other Jobs To Apply

No other job posts for this day.

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.


**This position offers a $5,000 sign on bonus with offer acceptance**

Job Summary:

Responsible for managing the 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 WellSense 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 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 WellSense 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

Qualifications:


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
  • 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
  • Demonstrates 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

About 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. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Back to blog

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

Data Entry Question and Answer

$150 $49

Remote Question and Answer

$150 $49

Virtual Assistant Question and Answer

$150 $49

Content Moderator Question and Answer

$150 $49

Customer Service Question and Answer

$150 $49

Video Game Tester Question and Answer

$150 $49

Related Posts