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Provider Relations Coordinator

Company: CareNational Healthcare Services
Location: Boston
Posted on: January 27, 2023

Job Description:

Provider Relations Coordinator
Boston, MA
** This is a Full Time, Benefits Available, opportunity **
**Must be willing to travel up to 60% of the time**

Responsible for managing assigned territory of professional, institutional and ancillary provider types in order to enhance these relationships so that Health Plan becomes their plan of choice.Serves as the primary liaison between 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.

ProviderRelations Rep Job Summary:

  • Provides a line of communication between the medical community, subscribers/members, clients and the Company.
  • Support Incoming email and faxes received in the Credentialing, Provider Information, and Public Plans departments.
  • Use email to send generated contracts to physicians
  • Follow instructions to save provider applications, and assign work to Provider Information team.
  • Train and learn how to search within claims and credentialing databases.
  • Receives telephone calls and answers routine questions.
  • Uses computerized systems for tracking, information gathering and troubleshooting.
  • Refers more complex inquiries and intakes to more senior level Provider Relations Representatives.

    ProviderNetwork AssistantBackground:

    • Requires an education level of at least a high school diploma or GED; Associate's degree is a plus.
    • At least 1 year experience in a medical office, hospital or health plan call center, or other healthcare support role with heavy computer, telephone, anddatabase use.
    • Strongly prefer 1 or more years at a Managed Care Organization (Health Plan, IPA/Medical Group, HMO, TPA/MSO, etc).
    • Basic knowledge of health care delivery systems, Managed Care Organizations as well as Medicaid/Medicare and related state programs is needed.
    • Proficient in Microsoft Office applications, with demonstrable skills in Word and Excel, and the ability to learn new and complex computer system applications.
    • Must have a minimum of 30 wpm typing with a high level of accuracy.
    • Excellent oral and written communication skills.


Keywords: CareNational Healthcare Services, Boston , Provider Relations Coordinator, Other , Boston, Massachusetts

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