Consultant, Provider Relations

BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 85,000 - 120,000; Full time

Job summary

BlueCross BlueShield of South Carolina is seeking a Provider Network Manager to establish and maintain relationships with network hospitals, physicians, and dental practices. You will serve as the primary contact for provider issues, analyze problems, and coordinate resolution efforts across multiple teams.

You will create educational materials, educate providers on lines of business, and document communications. Travel between buildings and some overnight stays may be required.

Qualifications

• Bachelor's degree required; degree equivalency accepted with related work experience.
• Five years of healthcare/provider network/claims management experience.
• Two of the five years with direct health plan/payer programs.
• Strong knowledge of automated medical management and claims systems.
• Ability to work independently, prioritize, and communicate effectively.

Responsibilities

• Serve as the primary contact for provider problems/issues.
• Respond to non-routine or difficult problems related to network contracts and policies.
• Determine root causes and coordinate/problem-resolution meetings.
• Create educational materials for providers and educate on lines of business.
• Explain coverage, navigation, and documentation requirements to providers.
• Document provider contacts in the education database.
• Conduct training on electronic filing, claims, and contract requirements.
• Lead workshops and speak at conferences as requested.
• Prepare/submits reports to management.

Skills

Customer service

Analytical thinking

Decision making

Presentation skills

Communication skills

Problem solving

Negotiation

Leadership

Education

Bachelor's degree

Degree Equivalency: 4 years experience or Associate's + 2 years

Tools

Microsoft Office

Job description

Summary

Establishes and maintains positive relationships with network hospitals, physician and/or dental practices, and their representatives. Serves as point of contact for provider problems/issues. Responds to non-routine or difficult problems/issues related to network contracts, reimbursement methodologies, benefit structure, medical policies, administrative policies, etc. Determines underlying cause(s) of problems and recommends changes to alleviate problems/issues. Coordinates/conducts meeting for problem resolution. Provides management with feedback on problems/issues.

Why should you join the BlueCross BlueShield of South Carolina family of companies?

Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Sponsorship: This position is not eligible for sponsorship now or in the future.

Location

This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM - 5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 4101 Percival Road Columbia, SC 29229.

What You’ll Do

Serves as point of contact for provider problems/issues. Responds to non-routine or difficult problems/issues related to network contracts, reimbursement methodologies, benefit structure, medical policies, administrative policies, etc.

Determines underlying cause(s) of problems and recommends changes to alleviate problems/issues. Coordinates/conducts meeting for problem resolution. Provides management with feedback on problems/issues.

Creates educational materials (webinars, brochures, etc.) for providers. Educates providers on all lines of business such as Medicare Advantage, BlueChoice, FEP, State, as well as our corporate products, including the Exchanges. Explains coverage, website navigation, utilization statistics, and documentation requirements by use of written advisories, reports, letters, bulletins, telephone contacts and in person visits. Documents all provider contacts and communications in the provider education database.

Conducts training in the following areas: electronic filing, reducing duplicate claims filings/incorrect claims filing, contract requirements, and reimbursements.

Conducts workshops and speaks at conferences/meetings/conventions, etc. as requested by hospitals/physician and/or dental practice groups.

Prepares/submits various reports to management.

To Qualify for This Position, You’ll Need the Following

• Required Education: Bachelor's
• Degree Equivalency: Four (4) years job related work experience or Associate's and two (2) years job related work experience.
• Required Work Experience: Five (5) years of healthcare, medical affairs, provider network, claims management, or combination of these. Two (2) of the Five (5) years must have been with direct health plan/payer programs.
• Required Skills and Abilities: Knowledge/understanding of automated medical management systems and claims processing systems. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Basic business math and knowledge of mathematical/statistical concepts. Ability to handle confidential or sensitive information with discretion. Ability to lead and motivate employees.
• Required Software and Tools: Microsoft Office
• Work Environment: Typical office environment. May involve some travel between buildings. Must be willing to travel and have reliable transportation. Some overnight stay is required.

We Prefer That You Have The Following

• Bachelor's degree-in Business Administration, Business Management, Healthcare Administration, Marketing, or other job related field.
• Preferred Work Experience: 3 years-of previous supervisory or management experience.
• Preferred Skills and Abilities: Knowledge of marketing and contracting.
• Preferred Software and Other Tools: Working knowledge of Microsoft Access or other database software.
• Preferred Licenses and Certificates: Active RN licensure in state hired or active LPN licensure in state hired.

Our Comprehensi