WellSense Health Plan · 2 days ago
Sr. Provider Relations Consultant--Springfield MA
Boston, MA
Contract
Hybrid
Mid, Senior Level
4+ years expWellSense Health Plan is a growing regional health insurance company committed to providing effective health insurance solutions. The Sr. Provider Relations Consultant will manage relationships with various provider types to enhance collaboration and ensure WellSense is the plan of choice for providers, while also serving as a liaison between providers and internal departments.
Hospital & Health Care
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
Qualification
Required
BA/BS required or related field, or an equivalent combination of education, training and experience
4 or more year's progressively responsible experience in provider relations or network management required
Must have valid driver's license and access to reliable transportation
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
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
Preferred
Experience in the Medicare provider healthcare insurance industry preferred
Benefits
Full-time remote work
Competitive salaries
Excellent benefits
Company
WellSense Health Plan
A nonprofit health plan serving Medicare, Individual & Family, and Medicaid plan members in Massachusetts & New Hampshire.
1001-5000 employees
H1B Sponsorship
WellSense Health Plan has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
2024 (8)
2023 (2)
2021 (2)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Heather Thiltgen
President & CEO
Diana Cruz
Chief Operating Officer
Company data provided by crunchbase