Provider Relations and Contract Operations Associate, 30hrs

Beth Israel Lahey Health•Woburn, MA

2d•$26 - $43

About The Position

This position is responsible for maintaining and updating the Highland Healthcare Associates IPA (IPA) Physician Information Database (Database) with demographic, contracted health plan, EMR, and other physician and practice specific data. The role involves making recommendations for database enhancements, ensuring data accuracy, enrolling and terminating physicians in health plans, and compiling physician rosters. The Associate will also participate in IPA committees and provide support for special projects to the Provider Relations and Contract Operations Manager and Specialists.

Requirements

At least three years of previous administrative experience.
Strong interpersonal, communication, and organizational skills required.
Excellent Microsoft Office skills required.
Ability and willingness to learn Salesforce CRM and other software programs.
Ability to work independently and with teams, work with time sensitive targets, respect for confidential nature of information, tact in dealing with sensitive issues, and flexibility.

Nice To Haves

Bachelor’s Degree preferred; additional directly relevant experience can be considered in lieu of degree.
Experience in a healthcare setting strongly preferred.
Experience with Salesforce or other CRM application beneficial.

Responsibilities

Maintains and updates the fields within the Database, assuring the accuracy and integrity of current physician and practice demographics, EMR, health plan, and other IPA and Network information.
Serves as subject matter expert as regards to Database content. Keeps appropriate IPA and Highland Management staff current on new physicians, physicians leaving the IPA, and physician and practice status changes. Produces database reports for internal and external customers. Educates other IPA staff on new database features and reports, as applicable. Provides regular physician demographic and health plan rosters to Network and contracted health plans, ensuring accuracy of each health plan’s data.
Makes recommendations for development of new database fields, reports, and other enhancements to meet and streamline health plan and IPA operations. Interacts with IPA staff and CRM vendor to implement database revisions and enhancements.
Posts website content, as requested. Ensures accuracy and integrity of website-based physician directories.
Supports Provider Relations and Contract Operations Specialist with enrolling physicians in the health plans under contract with the IPA and Network, including but not limited to distribution and collection of enrollment materials, interacting with the physicians and/or office staff and health plan credentialing staff, tracking enrollment, tracking IPA membership fees, and reviewing the accuracy of materials submitted to health plans and Network. Assists physicians and practice staff with completing physician termination notifications and status changes to ensure the integrity of communications to the health plans.
Provides support with physician enrollment functions for new IPA-Network health plan contracts.
Serves as a physician enrollment resource for the following: Credentialing Department of each contracted health plan, pertinent Winchester Hospital departments and IPA and Network staff.
Prepares for and coordinates key organizational meetings including: quarterly New Physician Orientation Meetings, Annual Practice Manager Meetings, Annual Physician Membership Meetings, and other meetings as assigned.
Serves as back-up resource to other Provider Relations and Contract Operations staff, as needed, by responding to phone calls and e-mail correspondence from physicians and their practice staff. Runs fee reports on a back-up basis, as needed.
Participates in special projects at the direction of Manager and/or Director.
Participates in mandatory training requirements as per hospital/unit policies.
Participates in continuing education/inservices to enhance knowledge.
Participates in staff meetings and other applicable department meetings.
Participates in performance improvement initiatives.
Participates in the orientation of new staff, students, and/or volunteers.