Provider Relations Consultant
Company: BMC HealthNet Plan
Location: New Bedford
Posted on: January 11, 2020
PROVIDER RELATIONS CONSULTANT
Acts as the primary liaison between Provider Relations Consultants
and internal Plan departments such as Claims, Benefits, Audit,
Member and Provider Enrollment and Clinical Services to effectively
identify and resolve claim issues. Works closely with the
leadership team to identify issues and report trends.
* Investigate, document, track, and assist with claims
* Interact with various operational departments to assure accurate
and timely payment of claims in accordance with the plan s policies
* Identify system changes impacting claims processing and work
internally on resolution.
* Identify systematic issues and trends and research for potential
configuration related work.
* Analyze trends in claims processing and assist in identifying and
* Run claim reports regularly to support external provider
* Develop and enhance our physician, clinician, community health
center and hospital relationships through effective business
interactions and outreach.
* Act as liaison for all reimbursement, issues with providers.
Facilitates resolution of complex contractual and member/provider
issues, collaborating with internal departments as necessary.
* As needed, provides general education and support on BMCHP
products, policies, procedures and operational issues.
* Manages flow of information to and from internal departments to
ensure communication regarding Plans changes and updates.
* May outreach to providers according to Plan initiatives.
* Facilitates 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.
* Processes reports as needed to support provider education,
servicing, credentialing and recruitment.
* Ensures quality and compliance with State Agencies and NCQA.
* Other responsibilities as assigned.
* Understanding and implementation of Plan polices &
* Regular and reliable attendance is an essential function of the
* Bachelor s degree in Business Administration, related field or an
equivalent combination of education, training and experience is
* 2 or more years of progressively responsible experience in a
managed care or healthcare environment is preferred.
* Experience with Medicare and Medicaid Reimbursement
* Understanding of provider coding and billing practices.
Certification or Conditions of Employment:
* Must have valid drivers license and access to a car.
Competencies, Skills, and Attributes:
* Experience with ICD-10, CPT/HCPCS Codes, and billing claim
* Ability to work as a team member, to manage multiple tasks, to be
flexible, and to work independently and possess excellent
* Proven expertise utilizing Microsoft Office products.
* Effective communication skills (verbal and written).
* Strong follow-up skills.
* Proficient in multi-tasking.
* Ability to set and manage priorities.
Working Conditions and Physical Effort:
* Travel up to 75%. Service area is Southeast.
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. BMC HealthNet? Plan/Well? Sense Plan participates
in the E-Verify Program to electronically verify the employment
eligibility of newly hired employees.
Keywords: BMC HealthNet Plan, New Bedford , Provider Relations Consultant, Other , New Bedford, Massachusetts
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