WellSense Health Plan · 2 days ago
Provider Relations Consultant NH
United States
Full-time
Remote
Entry, Mid Level
$58K/yr - $84K/yr
2+ years expWellSense Health Plan is a growing regional health insurance company with a 25-year history of providing health insurance that works for its members. The Provider Relations Consultant - NH will serve as the primary liaison between Provider Relations Consultants and internal departments to resolve claim issues and enhance provider relationships.
Hospital & Health Care
Responsibilities
Investigate, document, track, and assist with claims resolution
Interact with various operational departments to assure accurate and timely payment of claims in accordance with the plan's policies and procedures
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 quantifying issues
Run claim reports regularly to support external provider visits
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
Provides general education and support on WellSense products, policies, procedures and operational issues as needed
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
Understands and implements Plan polices & procedures
Qualification
Required
Bachelor's degree in Business Administration, related field or an equivalent combination of education, training and experience is required
Must have valid driver's license and access to a car
Experience with ICD-10, CPT/HCPCS Codes, and billing claim forms
Ability to work as a team member, to manage multiple tasks, to be flexible, and to work independently and possess excellent organizational skills
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
Preferred
2 or more years of progressively responsible experience in a managed care or healthcare environment is preferred
Experience with Medicare and Medicaid Reimbursement Methodologies
Understanding of provider coding and billing practices
Benefits
Medical
Dental
Vision
Pharmacy
Merit increases
Flexible Spending Accounts
403(b) savings matches
Paid time off
Career advancement opportunities
Resources to support employee and family wellbeing
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