WellSense Health Plan
Overview
Provider Relations Consultant role at WellSense Health Plan. WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire. WellSense is committed to diversity and inclusion of staff and members. 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. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees. Key Functions/Responsibilities
Develops and enhances relationships with assigned providers to include primary care providers, community health centers and hospital systems through effective business interactions and outreach. Collaborates with various WellSense departments to ensure accurate provider data and timely payment of claims, consistent with the plan's policies and procedures. Identifies system changes or trends impacting claims processing and payments and works internally on resolution. Produces reports as needed to support provider education, servicing, credentialing and network maintenance. This includes Provider Demographic reports, Panel Reports, Claim Detail reports, etc. Assists in the development of provider presentations that clearly communicate plan information and updates. Delivers presentations to provider groups, health systems, and provider forums. Meets with assigned providers regularly according to site visit servicing standards. Documents all pertinent provider communications and meeting notes in the customer relationship portal. Acts as liaison for all issues with providers including reimbursement, credentialing, claims, portal procedures, and issues of assigned providers. Facilitates resolution of complex contractual and member and provider issues, collaborating with internal departments as necessary. Outreaches to providers to support WellSense initiatives and assigned projects. Supports providers on member grievance questions and process. Provides education, training, and support on WellSense products, policies, procedures, web portal, and operational issues. Manages timely responses to and from internal departments to ensure effective communication regarding updates. Identifies system issues and updates needed; completes research related to provider data in plan systems. Manages flow of information to and from provider offices. Ensures active provider contacts are collected and in the plan’s system for effective mailing of plan notices and communication. Ensures quality and compliance with State Agencies and NCQA. Regular and reliable attendance is required. Qualifications
Bachelor’s degree in business administration or a related field or an equivalent combination of education, training and provider relations or network management experience is required. 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. Successful completion of pre-employment background check. Experience with ICD-10, CPT/HCPCS Codes, and billing claim forms. Ability to work as a team member, manage multiple tasks, be flexible, work independently, be pro-active, think outside the box, 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 and thrive in a fast-paced environment. Working Conditions
Must be willing to travel to assigned providers for servicing to meet business needs up to 50% of time. Must be able to travel to multiple provider offices across a wide geographic area on a regular basis, often within the same day. In office work performed in a typical remote home office environment. Benefits
Full-time remote work Competitive salaries Excellent benefits
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Provider Relations Consultant role at WellSense Health Plan. WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire. WellSense is committed to diversity and inclusion of staff and members. 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. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees. Key Functions/Responsibilities
Develops and enhances relationships with assigned providers to include primary care providers, community health centers and hospital systems through effective business interactions and outreach. Collaborates with various WellSense departments to ensure accurate provider data and timely payment of claims, consistent with the plan's policies and procedures. Identifies system changes or trends impacting claims processing and payments and works internally on resolution. Produces reports as needed to support provider education, servicing, credentialing and network maintenance. This includes Provider Demographic reports, Panel Reports, Claim Detail reports, etc. Assists in the development of provider presentations that clearly communicate plan information and updates. Delivers presentations to provider groups, health systems, and provider forums. Meets with assigned providers regularly according to site visit servicing standards. Documents all pertinent provider communications and meeting notes in the customer relationship portal. Acts as liaison for all issues with providers including reimbursement, credentialing, claims, portal procedures, and issues of assigned providers. Facilitates resolution of complex contractual and member and provider issues, collaborating with internal departments as necessary. Outreaches to providers to support WellSense initiatives and assigned projects. Supports providers on member grievance questions and process. Provides education, training, and support on WellSense products, policies, procedures, web portal, and operational issues. Manages timely responses to and from internal departments to ensure effective communication regarding updates. Identifies system issues and updates needed; completes research related to provider data in plan systems. Manages flow of information to and from provider offices. Ensures active provider contacts are collected and in the plan’s system for effective mailing of plan notices and communication. Ensures quality and compliance with State Agencies and NCQA. Regular and reliable attendance is required. Qualifications
Bachelor’s degree in business administration or a related field or an equivalent combination of education, training and provider relations or network management experience is required. 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. Successful completion of pre-employment background check. Experience with ICD-10, CPT/HCPCS Codes, and billing claim forms. Ability to work as a team member, manage multiple tasks, be flexible, work independently, be pro-active, think outside the box, 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 and thrive in a fast-paced environment. Working Conditions
Must be willing to travel to assigned providers for servicing to meet business needs up to 50% of time. Must be able to travel to multiple provider offices across a wide geographic area on a regular basis, often within the same day. In office work performed in a typical remote home office environment. Benefits
Full-time remote work Competitive salaries Excellent benefits
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