Top Provider Network Executive jobs in Boston, MA
Top Provider Network Executive plans and directs all aspects of an organization's provider network function. Responsible for developing the network and negotiating and administering contracts. Being a Top Provider Network Executive oversees provider relations and monitors and directs all provider services. Requires a bachelor's degree. Additionally, Top Provider Network Executive typically reports to a top management. The Top Provider Network Executive manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. To be a Top Provider Network Executive typically requires 8+ years of managerial experience. Comprehensive knowledge of the overall departmental function. (Copyright 2024 Salary.com)
Recently Added Top Provider Network Executive jobs
Sr. Provider Relations Consultant
- Top Tier Reps LLC
-
Boston, MA
FULL_TIME
-
Salary: $75,000 - $85,000 per year
*** Guaranteed $5,000 sign-on bonus***
Responsible for managing assigned territory of professional, institutional, and ancillary provider types to enhance these relationships so that the company becomes their plan of choice. Serves as the primary liaison between the company (“Plan”) and key provider organizations, taking the lead and promoting collaboration within the Plan, as it relates to provider network maintenance.
Manages territory inclusive of one or more of the highest priority network partnerships, as well as multiple other providers, facilities, and community health centers. Works closely with the Provider Relations Supervisor to identify issues and report trends. Acts as liaison between provider and internal Plan departments such as Provider Enrollment, Claims, Audit, Marketing, Customer Care, and Care Management.
Benefits:
Full-time remote work
Competitive salaries
Excellent benefits
Key Functions/Responsibilities:- Develops and enhances our physician, clinician, community health center, and hospital relationships through effective business interactions and outreach.
- Works collaboratively with Provider Relations Consultants and Supervisors to develop and update provider orientation programs.
- Coaches and assists in the training of Provider Relations Consultants and Provider Relations Specialists.
- Organizes, prepares, and conducts orientations of network providers (administrative and clinical) and their staff.
- Takes the lead on specific Plan initiatives as they relate to provider education.
- Provides general instruction and support on BMCHP products and policies to providers and coordinates office and provider site clinical and administrative meetings.
- Meets with assigned providers regularly according to pre-set site visit servicing standards.
- Acts as liaison for all reimbursement, credentialing, claims, EDI web site procedures and issues of key providers.
- Facilitates resolution of complex contractual and member/provider issues, collaborating with internal departments as necessary.
- Works collaboratively with Contract Managers in implementing and administering contractual provisions of provider agreements to ensure contractual compliance.
- Manages flow of information to and from provider offices.
- Monitors and communicates market trends and issues.
- Outreaches to providers according to Plan initiatives.
- Analyzes operational issues about territory and provider operations such that interrelationships among other area providers are considered.
- Facilitates timely problem resolution.
- Initiates Plan interdepartmental collaboration to resolve complex provider issues.
- Identifies system updates needed and completes research related to provider data in Onyx and Facets.
- Represents Provider Relations and the plan at external provider and community events to maintain a visible presence.
- Processes reports as needed to support provider education, servicing, credentialing, and recruitment.
- Assists in developing marketing materials.
- Participates in community outreach activities and events.
- Ensures quality and compliance with state Medicaid regulations and NCQA requirements.
- Other responsibilities as assigned.
- BA/BS required or related field, or an equivalent combination of education, training, and experience.
- 4 or more year’s progressively responsible experience in provider relations or network management is required.
- Experience in the Medicare provider healthcare insurance industry preferred.
- Must have a valid driver’s license and access to reliable transportation.
- Knowledge or familiarity with Medicaid and Medicare is required.
- Understanding of the local provider community.
- Proven demonstration of effective communication skills (verbal and written), and interpersonal skills.
- Demonstrated ability to establish, build, and maintain relationships with internal and external constituents.
- Strong analytical, research, and organizational skills.
- Strong follow-up skills.
- Ability to think and react quickly to address questions and issues while interacting with the provider community.
- Foster an atmosphere of collaboration and teamwork internally and externally.
- Demonstrate initiative, judgment, discretion, and ability to operate within a politically sensitive framework.
- Ability to be flexible, work independently, and manage multiple tasks.
- Demonstrated competence using Microsoft Office products, especially Excel and Access. familiarity with FACETS helpful.
- Must be willing to travel significantly to local communities to meet business needs up to 50% of the time.
- Ability to work in a fast-paced environment.
- 6 Days Ago
Remote Clinical Psychologist (PsyD or PhD)
- Maven Clinic 1099 Provider Network
-
Boston, MA
FULL_TIME
- Maven is looking for a mission-driven, empathetic PsyD to support our members through virtual care services. As a Maven provider, you will have the opportunity to meet with adult members across the Un...
- 1 Month Ago
Executive Director Of Network
- TEKsystems c/o Allegis Group
-
Boston, MA
FULL_TIME
- Job DetailsDescription: Who Our Client Is: Our client is a Post-Trade financial services company. They provide solutions to support clearing and settlement services to financial markets. Through their...
- 4 Days Ago
Remote - Provider Network Strategy Intern
- Commonwealth Care Alliance
-
Boston, MA
INTERN
- Why This Role is Important to Us: Commonwealth Care Alliance (CCA) is thrilled once again to host its Summer Internship Program for clinical and non-clinical departments this year! The Internship Prog...
- 6 Days Ago
Manager, Provider Network Contracting - New England market
- The Cigna Group
-
Newton, MA
OTHER,FULL_TIME
- LOCATION: Based in Newton, MA officeThe Manager, Provider Network Contracting serves as an integral member of the Provider Contracting Team and reports to the Provider Contracting Senior Manager. This...
- 13 Days Ago
Executive Assistant with MCAN Central Office
- Massachusetts Communities Action Network
-
Boston, MA
FULL_TIME
- Executive Assistant Job Description JOB DESCRIPTION Massachusetts Communities Action Network (MCAN) seeks a dynamic, justice-focused executive assistant to join our team. This position provides high-l...
- 3 Days Ago
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0 Top Provider Network Executive jobs found in Boston, MA area
Executive Assistant to the Deans Office
- Tufts University
-
Boston, MA
- Overview: The Office of the Dean is responsible for the academic and administrative functions of Tufts University School...
- 4/19/2024 12:00:00 AM
Office Manager/Executive Assistant
- Confidential
-
Boston, MA
- Monument Staffing, on behalf of our client located in Boston, MA, is hiring a full-time, permanent Office Manager/Execut...
- 4/18/2024 12:00:00 AM
Chief Executive Officer
- Green Mattress
-
Brockton, MA
- Role Overview Green Mattress is an industrial processing business serving the recycled products and raw materials indust...
- 4/17/2024 12:00:00 AM
Executive Assistant to the Commissioners Office
- NR Consulting
-
Boston, MA
- Job title: Executive Assistant to the Commissioners Office Job ID : 730525 Location: Boston, MA 02111 Client: Commonweal...
- 4/17/2024 12:00:00 AM
Office Operations Administrator & Executive Assistant
- Monte Rosa Therapeutics
-
Boston, MA
- Office Operations Administrator & Executive Assistant Boston, MA (onsite) We seek an experienced, highly motivated, and ...
- 4/17/2024 12:00:00 AM
Chief Executive Officer
- Green Mattress
-
Brockton, MA
- Role Overview Green Mattress is an industrial processing business serving the recycled products and raw materials indust...
- 4/16/2024 12:00:00 AM
Office Operations Administrator & Executive Assistant
- Monte Rosa Therapeutics
-
Boston, MA
- Office Operations Administrator & Executive Assistant Boston, MA (onsite) We seek an experienced, highly motivated, and ...
- 4/16/2024 12:00:00 AM
Executive Office Administrator
- The Newbury Boston
-
Boston, MA
- Compensation Type: Hourly Highgate Hotels: Highgate is a premier real estate investment and hospitality management compa...
- 2/9/2024 12:00:00 AM
About Boston, Massachusetts
Boston has an area of 89.63 square miles (232.1 km2)—48.4 square miles (125.4 km2) (54%) of land and 41.2 square miles (106.7 km2) (46%) of water. The city's official elevation, as measured at Logan International Airport, is 19 ft (5.8 m) above sea level. The highest point in Boston is Bellevue Hill at 330 feet (100 m) above sea level, and the lowest point is at sea level. Situated onshore of the Atlantic Ocean, Boston is the only state capital in the contiguous United States with an oceanic shoreline.
Boston is surrounded by the "Greater Boston" region and is contiguously bordered by the citi...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Top Provider Network Executive jobs
$443,779 to $821,779
Boston, Massachusetts area prices
were up 2.5% from a year ago
were up 2.5% from a year ago