Sr Provider Relations Liaison

Position Summary:

The Senior Provider Relations Specialist is responsible for building, maintaining and strengthening relationships with the Commonwealth Care Alliance's (CCA) diverse provider community - including physician, hospital, behavioral health, community-based, LTSS, and HCBS providers. This individual serves as a key liaison, proactively addressing provider needs, ensuring regulatory compliance, and supporting operational excellence to enhance provider satisfaction and member access to care.

Reporting to the Senior , Director of Delegation Partnerships., the Senior Provider Relations Account Manager will:

• Lead provider servicing activities, including onboarding, orientation presentations, and ongoing education initiatives.
• Serve as a primary resource for resolving provider inquiries and supporting issue resolution.
• Collaborate in the implementation of CCA's enterprise-wide provider engagement strategy, focused on delivering a best-in-class provider experience.
• Utilize strategic planning and data-driven insights to identify opportunities for continuous improvement in provider relations and organizational performance.

By fostering strong partnerships and supporting process enhancements, the Senior Provider Relations Account Manager plays a vital role in helping CCA achieve its mission and goals within the provider community.

Supervision Exercised:

• No, this position does not have direct reports.
  

Essential Duties & Responsibilities:

• Relationship Management
  • Develop strong professional relationships with providers across all specialties -, physician, hospital, behavioral health, community based, and ancillary providers and their staff.
  • Serve as the primary liaison to the provider community, researching, resolving, and escalating complex provider issues as needed.
  • Own provider relationships to drive satisfaction, retention, and operational efficiency.
• Provider Education and Support:
  • Facilitate and lead communication sessions, educating on CCA's policies, program benefits, billing, referral and authorizations regulatory compliance, and contractual expectations. Conduct orientation and ongoing education (virtual and in-person) for new and existing providers.
  • Identify and address training needs, collaborating with internal education and training teams to develop materials.
• Operational Excellence:
  • Collaborate with cross-functional teams (e.g., Claims, Credentialing, Clinical Care Management, Member Services, Provider Services, Regulatory Affairs, Marketing) to resolve provider issues and reduce administrative burden.
• Conduct site visits when necessary and coordinate with credentialing department to ensure the collection of required applications and other credentialing documentation
• Manage and respond to a high volume of provider inquiries while ensuring consistent follow through on resolution of issues
• Prioritize and organize own work to meet deadlines
• Work collaboratively with Provider Network Management staff to ensure an adequate and appropriate provider network When necessary, participate in contracting strategy discussions around potential recruitment opportunities
• Coordinate with other CCA departments, including Clinical Management, Member Services, Claims, Regulatory Affairs, Outreach and Marketing, to resolve provider issues. Attend and participate in department staff meetings
• Assists in the development of training materials and training of Provider Relations Specialists.
• Assist with designated provider communication tasks.
• Special projects as assigned or directed

Working Conditions:

• Standard office conditions.
• This is a remote or hybrid role with the expectation of working according to Commonwealth Care Alliance's standard operating hours of 8:30am-5pm Monday-Friday.

Required Education (must have):

• Bachelor's Degree or equivalent experience

Desired Education (nice to have):

Required Licensing (must have):

Desired Licensing (nice to have):

MA Health Enrollment (required if licensed in Massachusetts):

• No, this is not required for the job.

Required Experience (must have):

• 5+ years of experience

Desired Experience (nice to have):

• Experience with dual-eligible (DSNP) populations preferred.

Required Knowledge, Skills & Abilities (must have):

• Strong claims experience
• Mentoring subject matter expert of the team
• Managed Care experience (preferably Medicare/Medicaid)
• Experience in health plan provider relations
• Experience with behavioral health providers preferred
• 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 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

Valid Driver's license and reliable insured automobile required

Required Language (must have):

• English

Desired Knowledge, Skills, Abilities & Language (nice to have):