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PROVIDER RELATIONS REP I in Woburn, MA at Beacon Health Options

Date Posted: 3/27/2019

Job Snapshot

Job Description

General Summary  

Provides internal support and follow-through in completion of the Provider Relations function. This position supports the local Manager, Provider Relations, by providing research, problem resolution and follow-up on a variety of provider issues that may arise.  The job also coordinates activities with other internal Beacon Health Options departments to provide optimal customer service to network providers and internal customers.

Essential Functions and Responsibilities

  1. Answer general provider questions about Beacon, its contracts, policies and procedures.

  2. Perform research and problem resolution on issues related to provider complaints, claims reported to have been processed incorrectly, coordinating credentialing paperwork, provider communications, or verification of information as requested.

  3. Remain current on regulatory and company policy that impacts the provider network and related issues.

  4. Answer practitioner/facility recruitment questions regarding joining Beacon’s network.

  5. Provide assistance in compilation and mailing of provider recruitment mailings, general information, and educational materials to network practitioners as required.

  6. Conduct outreach to providers for information, research or compliance with Beacon policies or programs including access and availability standards.

  7. Provide follow up with key practitioners and facilities for the return of completed credentialing and re-credentialing applications

  8. Provide general support to all network development activities.

  9. Respond to provider calls transferred by the Provider Services Line as well as emails, voicemails and faxes.

  10. Actively outreach and train providers to increase the rate of electronic transactions.

  11. Perform active outreach to ensure compliance with access and availability.

  12. Work with providers and network operations to ensure provider data submission and accuracy.

  13. Participate in the coordination and processing of all Network department mailings.

  14. Review claim reports for denial rates and work with providers to improve claim submissions.

  15. Build collaborative relationships with client health plan counterparts to ensure seamless customer service.

  16. Assists with network reporting activities.


  1. Maintain professional growth and development through self-directed learning activities.

  2. Adhere to all Beacon policies and procedures and standards of operations.

  3. Complete all required and assigned trainings.

  4. Attend all mandatory company or department meetings.

  5. Display a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.

  6. Assist team members and offers suggestions to improve processes, culture, or work environment.

  7. Performs special projects and other duties as assigned and required.

  8. Ensure compliance with regulatory and NCQA requirements

Minimum Entry Level Qualifications

  • Education: High School diploma or GED required.  Some college preferred      

  • Minimum 2 years’ experience in health care field.

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email ( Only candidates who have applied for an open position through our Careers page ( will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.