Provider Relations Specialist

Company Name:
MMS Group
Provider Relations Specialist - WALTHAM, MA and BEDFORD, NH
Progressive health plan is a leader in the MA and NH markets ! You will be a very important liaison in developing effective collaboration between the plan and participating providers and healthcare systems in the MA marketplace. You will conduct orientation and training related to plan policies and procedures, conduct regular meetings with the providers documenting discussions, issues, attendees, and action items. You will provide on-going coaching for performance improvement within the physician practices. Coordinate activity and communication among providers, the health plan and corporate office including investigating and resolving complex provider claims issues. You will be a leader for internal meetings, internal projects and provider outreach initiatives.
Ideal candidate will have a Bachelors degree in a related field, 4-6 years of provider billing experience or experience in managed care or health insurance environment. Knowledge of health care, managed care and claims billing/coding knowledge required. Medicare or Medicaid knowledge highly desirable. In-depth knowledge of Amysis, Business Objects, Portico and other systems necessary. Must have a good driving record and the ability to travel around assigned territory in MA.

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