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.