Provider Relations Manager - Healthcare Resume Search
Provider Relations Manager - Healthcare Resume Search
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Provider Relations Manager Resume

Desired Industry: Healthcare SpiderID: 62371
Desired Job Location: dedham, Massachusetts Date Posted: 7/18/2012
Type of Position: Full-Time Permanent Availability Date: 2 weeks
Desired Wage: 65,000
U.S. Work Authorization: Yes
Job Level: Experienced with over 2 years experience Willing to Travel: Yes, 50-75%
Highest Degree Attained: Bachelors Willing to Relocate: No

•Over 9 years of experience as a Public Relations Representative.
•Professional appearance and excellent interpersonal and communication skills.
•Hard working, flexible and able to angle responsibility.
•Proven ability in learning and implanting new procedures.
•Able to interact within an organization at all levels.

Southeastern Reg Voc Tech, diploma. Northeastern, some college

2011-Current: Steward Health Care Network
Sr Provider Relations Manager
• Meet regularly with PO leadership reviewing SHCN strategic priorities and initiatives to achieve performance targets.
• Evaluate, negotiate and recommend necessary changes to existing contracts to ensure that targeted provider performance and financial goals are met.
• Meets regularly with physician practices in assigned territory and establishes excellent working relationships with staff and promoting the benefits belonging to the Steward network
• Orients and trains office staff on new health plan contracts as needed. Assists in resolving any operational issues with the health plans
• Develop information to report on overall performance and to support their specific initiatives. Analyze performance, identify drivers, issues of practice variation, and develop recommendations for improvement. Works to influence change to effect strong performance results
• Develop and deliver training and education to Steward affiliated physicians and their office staff in the areas of quality improvement and medical management and electronic technology
• Communicates new SHCN programs and policies or changes in existing programs, such as referral and leakage management and quality improvement initiatives and provides appropriate trainings

2009-2011: Neighborhood Health Plan, Boston MA
Provider Relations Manager
• Primary liaison between NHP and the provider community
• Dedicated Provider Relations Representative assigned to the North Shore contracted providers.
• Monitor joint contract compliance and operation performance
• Manage information flow to and from provider offices
• Manage and conduct all face to face meetings along with on-site trainings
• Develop and provide appropriate network management and analysis reports
• Facilitate the timely Credentialing and Re-Credentialing efforts of NHP providers
• Develop, Coordinate and Implement provider educational materials.

2007-2009: Blue Cross Blue Shield of Massachusetts, Boston MA
Provider Relation Coordinator/Manager-
• Educate Providers on BCBS products, policies and procedures.
• Manage the collection and follow-up of information for all aspects of provider credentialing and physician office review.
• Continuously monitor implementation of new and/or revised contracts and contract checklists.
• Manage the corporate interdependencies to assure timely resolution of complex provider issues to strengthen partnerships.
• Assist with the distribution of provider communications and ensure understanding at face to face meetings.
• Actively participate in POST and provider technology training as needed
• Provide project management responsibilities as needed which may include coordination of projects to meet regional, divisional and corporate initiatives.
• Assist in the design and implementation of solutions to Provider issues and problems. Serve as a resource for providers and their staff regarding medical management initiatives, electronic technology issues, new programs and products.
• Actively provide support in contract compliance and audit initiatives.

Project Coordinator 2005-2007
• Responsible for maintaining the eRx Collaborative Program guidelines
• Lead support for Provider survey, including input all data and provide additional support as needed
• Lead effort to benchmark other eHealth initiatives and share relevant news/results with the team
• Manage ePrescribing license renewal process, including monthly meetings with vendors, making decision for exceptions
• Manage ePrescribing vendor evaluation Process: Including maintain project plans, updating evaluation forms, updating vendor requirements, sending out letters/evaluation forms, schedule demo, and make decision
• Responsible for managing invoice process for ePrescribing vendors
• Test BCBSMA formulary on DrFirst and Zix application to ensure it is displayed correctly (1 hour monthly)
• Manage HPIP updates, measurement tracking and provide overall documentation support
• Provide tracking support for PCPIP appeals and attend weekly meetings

Research Administrative Assistant 2003-2005
• Assist the research manager in obtaining current scientific literature via Medline and other external sources crucial to policy development and benchmarking BCBSMA medical policies and HCFA medical policies
• Solicit physician input from the Massachusetts Medical Society and other physicians regarding each provider’s priorities, including new scientific publications for discussion at monthly Medical Policy Group Meetings
• Prepare and coordinate medical policies and scientific background for medical policy group meetings
• Write medical policy group meetings
• Create quarterly CPT and HCPCS transactions reports

Member Service Representative 2002-2003
• Answering high volume calls within a call center
• Replying to all billing inquiries
• Verifying benefits with providers
• Process claim status and adjustments
• Provide excelled concierge service to our customers

benchmarking, benefits administration, billing, call center, contract management, cpt, delivery, documentation, forms, letters, management, meeting facilitation, microsoft office, policy analysis, project management, project planning, publicity, research, scientific, telephone skills, troubleshooting, Sharepoint, powerpoint, project, HDS System, QXNT.

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