Provider Relations Liaison

011230 CA-Provider Engagement & Performance Position Summary 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. Supervision Exercised: No Essential Duties & Responsibilities Develop 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. Take ownership of the provider relationship, ensuring all provider needs and concerns are addressed and answered. Establish regular contact with and visits to provider sites. Visits may include regular operations meetings, staff education, provider orientations, and appreciation events. Facilitate and lead orientation meetings and communication sessions with key providers; orient 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. Identify opportunities for training and education. Conduct site visits with contracting, sales and marketing departments to ensure the collection of required applications and other documentation. Manage and respond to a high volume of provider inquiries while ensuring consistent follow through on resolution of issues. Represent CCA at provider related events and other initiatives, as necessary. Prioritize and organize own work to meet deadlines. Work collaboratively with Provider Network Management staff to ensure an adequate and appropriate provider network. Participate in contracting strategy discussions around potential recruitment opportunities. Coordinate with other CCA departments, including Clinical Management, Member Services, Regulatory Affairs, Claims and Outreach and Marketing, to resolve provider issues. Participate in departmental and interdepartmental meetings as appropriate and necessary Participate in the development of departmental policies, procedures and processes. Special projects as assigned or directed. Maintain 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. Introduce yourself to our recruiters and we'll get in touch if there's a role that seems like a good match. Commonwealth Care Alliance® (CCA) is a mission-driven healthcare services organization that offers high-quality health plans and care delivery programs designed for individuals with the most significant needs. Serving more than 100,000 individuals across Massachusetts, Rhode Island, Michigan, and California, CCA delivers comprehensive, integrated, and person-centered care by coordinating the services of local staff, provider partners, and community organizations. CCA’s unique model of uncommon care® has achieved an unparalleled track record of improved health and quality outcomes and lower costs of care.

Salary : $54,800 - $82,200