• Job Description

  Req#: 7965

  Overview

  About us:

  Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

  Brief Summary of Purpose:

  The Senior Provider Relations Representative serves as primary liaison for operational matters between FCHP and all contracted and non-contracted physicians/providers, hospitals, and ancillary providers within an assigned territory. The Senior Provider Representative is responsible for building and maintaining positive relationships with FCHP’s network of providers in order to help advance the company vision. This position is a subject matter expert in Provider Relations and is a knowledgeable resource for Provider Relations Representative and other associates both internal and external.

  Responsibilities

  Job Responsibilities:

  Build and manage relationships with FCHP contracted provider’s and non-contracted providers

  • Develops and support relationships with key contacts at provider groups
  • Identify and track critical operational issues
  • Work collaboratively with internal partners to reduce provider abrasion and implement long term solutions and resolution to problems identified in a timely manner
  • Support FCHP sales and outreach initiatives as appropriate

  Training/Education of Providers

  • Plan, organize and conduct educational training seminars for assigned provider network to include newly contracted and ongoing education
  • Continue to visit providers/customers to educate and foster positive relationship with FCHP
  • Educate providers/facilities on new initiatives; support the development and implementation of new initiatives

  Communication

  • Proactively communicate policy edits or procedural changes to providers
  • Facilitate and lead face-to-face meetings and calls with providers and within FCHP
  • Ability to converse with all levels of positions both internally and externally
  • Contributes to generating articles for the Connection Newsletter

  Administrative

  • Assist with interview process and on-boarding of new hires.
  • Act as a role model and resource for other Provider Relations Representatives
  • Support team members and provide support to other territories as needed
  • Documents provider issues and maintains accurate key contact information for territory
  • May participate
  • Assists to the upkeep of the provider site, contribute when appropriate to ongoing provider communications
  • Represent FCHP at outside professional associations such as MGMA, MMS, HCAS and MAPAM
  • Support the development, implementation and ongoing maintenance company initiatives, policy, procedure, and operations
  • Escalates conflicts to Manager of Provider Relations and when appropriate, Director of Provider Relations.

  Contract Knowledge

  • Coordinate and facilitate implementation of new contracts
  • Ability to analyze and interpret data to proactively manage provider relationships; run claims reports and interpret issue
  • Demonstrates thorough knowledge of provider contract terms and payment methodology
  • Participates in joint operating committees and other committees as appropriate

  Qualifications

  Education:

  • Bachelor’s degree
  • Healthcare administration training highly desirable

  License/Certifications:

  Driver’s License

  Experience:

  • 5-7 years experience in healthcare with a minimum of 3 years in provider relations preferred
  • Working knowledge of provider offices and relationship with healthcare plans preferred

  Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

• About the company

  Health tips, info about how to best use your health insurance, community events & Fallon in the news

Notice