Provider Relations Liaison

Provider Relations Liaison

The Provider Relations Liaison is responsible for cultivating, maintaining, and strengthening relationships with the Commonwealth Care Alliance's (CCA) provider community. In this highly visible field position, the provider relations specialist acts as the primary liaison between CCA and its providers including primary care practices, specialists, physician organizations, hospitals, ancillary and LTSS providers. Key responsibilities include establishing positive working relationships with providers, effectively communicating with and educating those providers about CCA and resolving provider inquiries.

Essential duties and responsibilities include developing strong professional relationships with all providers and their staff while functioning as a liaison to the provider community to research and resolve complex provider issues. Taking ownership of the provider relationship, ensuring all provider needs and concerns are addressed and answered. Establishing regular contact with and visits to provider sites. Facilitating and leading orientation meetings and communication sessions with key providers; orienting providers on CCA's policies related to claims and service recovery, program benefits, clinical initiatives, referral and authorization, regulatory compliance, billing and payments, complaints and appeals, policies and procedures. Identifying opportunities for training and education. Conducting site visits with contracting, sales and marketing departments to ensure the collection of required applications and other documentation. Managing and responding to a high volume of provider inquiries while ensuring consistent follow through on resolution of issues. Representing CCA at provider related events and other initiatives, as necessary. Prioritizing and organizing own work to meet deadlines. Working collaboratively with Provider Network Management staff to ensure an adequate and appropriate provider network. Participating in contracting strategy discussions around potential recruitment opportunities. Coordinating with other CCA departments, including Clinical Management, Member Services, Regulatory Affairs, Claims and Outreach and Marketing, to resolve provider issues. Participating in departmental and interdepartmental meetings as appropriate and necessary. Participating in the development of departmental policies, procedures and processes. Special projects as assigned or directed. Maintaining professional growth and development.

Working conditions : Standard office conditions.

Education (Required) : Bachelor's Degree or equivalent experience

Experience (Required) : 3-5 years Managed Care experience Experience in health plan provider relations.

Experience (Desired) : Medicare / Medicaid experience preferred. Experience with CPT coding and authorization process highly desired. Experience with and understanding of claims operations preferred.

Knowledge, Skills & Abilities (Required) : Understanding of provider office operations as they relate to health plans. Knowledge of billing practices and reimbursement methodologies. Excellent verbal, written and presentation skills. Outstanding Customer Service Skills. Intermediate Microsoft Office competency, including Outlook, Word, Excel & Power Point. Ability to multi-task. Ability to work independently. Ability to interact well with individuals on all levels, and maintain a professional image and attitude. Strong analytical, problem solving and project management skills. Detail oriented, with the ability to organize and manage multiple priorities.

Language(s) : English Fluency

Other : Valid Driver's license and reliable insured automobile required. Must be able to travel within an assigned territory on a daily basis.

Compensation Range / Target : $54,800 - $82,200 Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. EEO is The Law Equal Opportunity Employer Minorities / Women / Protected Veterans / Disabled Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.