WellSense Health Plan
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Provider Relations Consultant NH
role at
WellSense Health Plan
It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary The Provider Relations Consultant - NH will act 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. This individual will also work closely with the leadership team to identify issues and report trends.
Our Investment In You
Full‑time remote work
Competitive salaries
Excellent benefits
Key Functions/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
Facilitate resolution of complex contractual and member/provider issues, collaborating with internal departments as necessary
Provide general education and support on WellSense products, policies, procedures and operational issues as needed
Manage flow of information to and from internal departments to ensure communication regarding Plan changes and updates
May outreach to providers according to Plan initiatives
Facilitate problem resolution
Identify system updates needed and complete research related to provider data in Onyx and Facets
Process reports as needed to support provider education, servicing, credentialing and recruitment
Ensure quality and compliance with State Agencies and NCQA
Other responsibilities as assigned
Understand and implement Plan policies & procedures
Initiates Plan interdepartmental collaboration to resolve complex provider issues
Initiates Plan interdepartmental collaboration to resolve complex provider issues
Qualifications Education
Bachelor’s degree in Business Administration, related field or an equivalent combination of education, training and experience is required
Experience
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
Certification Or Conditions Of Employment
Must have valid driver’s license and access to a car
Competencies, Skills, And Attributes
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
Working Conditions And Physical Effort
Travel up to 50%
Compensation Range $57,500- $83,500
This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.
Note: This range is based on Boston-area data, and is subject to modification based on geographic location.
About WellSense WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their 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.
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Provider Relations Consultant NH
role at
WellSense Health Plan
It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary The Provider Relations Consultant - NH will act 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. This individual will also work closely with the leadership team to identify issues and report trends.
Our Investment In You
Full‑time remote work
Competitive salaries
Excellent benefits
Key Functions/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
Facilitate resolution of complex contractual and member/provider issues, collaborating with internal departments as necessary
Provide general education and support on WellSense products, policies, procedures and operational issues as needed
Manage flow of information to and from internal departments to ensure communication regarding Plan changes and updates
May outreach to providers according to Plan initiatives
Facilitate problem resolution
Identify system updates needed and complete research related to provider data in Onyx and Facets
Process reports as needed to support provider education, servicing, credentialing and recruitment
Ensure quality and compliance with State Agencies and NCQA
Other responsibilities as assigned
Understand and implement Plan policies & procedures
Initiates Plan interdepartmental collaboration to resolve complex provider issues
Initiates Plan interdepartmental collaboration to resolve complex provider issues
Qualifications Education
Bachelor’s degree in Business Administration, related field or an equivalent combination of education, training and experience is required
Experience
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
Certification Or Conditions Of Employment
Must have valid driver’s license and access to a car
Competencies, Skills, And Attributes
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
Working Conditions And Physical Effort
Travel up to 50%
Compensation Range $57,500- $83,500
This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.
Note: This range is based on Boston-area data, and is subject to modification based on geographic location.
About WellSense WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their 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.
#J-18808-Ljbffr