Consultant, Provider Relations

001 BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 65,000 - 90,000; Full time

Job summary

BlueCross BlueShield of South Carolina is seeking a dedicated provider relations professional to establish and maintain positive relationships with network hospitals, physicians and dental practices in Columbia, SC. You will be the primary contact for provider issues, addressing complex problems related to contracts, reimbursements, policies, and administration.

The role requires at least 5 years in healthcare/provider network roles, with some experience in health plan/payer programs.

Qualifications

• Bachelor's degree equivalency: 4 years related work experience or Associate's degree with 2 years related work experience.
• 5 years of healthcare, medical affairs, provider network, claims management, or related experience; 2 of the 5 years must have been with direct health plan/payer programs.

Responsibilities

• Serve as the point of contact for provider problems/issues.
• Respond to non-routine or difficult problems related to network contracts, reimbursement methodologies, benefit structure, medical policies, and administrative policies.
• Identify root causes and recommend changes to alleviate problems/issues.
• Coordinate and conduct meetings for problem resolution.
• Provide management with feedback on problems/issues.
• Create educational materials (webinars, brochures) for providers.
• Educate providers on lines of business such as Medicare Advantage, BlueChoice, FEP, State, and Exchanges.
• Explain coverage, website navigation, utilization statistics, and documentation requirements via advisories, reports, letters, bulletins, or in-person visits.
• Document all provider contacts in the education database.
• Conduct training in electronic filing, reducing duplicate/incorrect claims filing, contract requirements, and reimbursements.
• Lead workshops and speak at conferences as requested by hospitals/physician and/or dental practice groups.
• Prepare and submit various reports to management.

Skills

Microsoft Office

Marketing knowledge

Contracting knowledge

Database knowledge

Education

Bachelor's degree equivalency

Tools

Microsoft Access

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 you should join

BlueCross BlueShield of South Carolina is part of the national landscape for more than seven decades, with 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.

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

Location and Working Hours

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 dentalpractice groups.
• Prepares/submits various reports to management.

To Qualify for This Position

• Required Education: Bachelor's Degree equivalency: 4 years job related work experience or Associate's and 2 years job related work experience.
• Required Work Experience: 5 years of healthcare, medical affairs, provider network, claims management, or combination of these. 2 of the 5 years must have been with direct health plan/payer programs.

We Prefer That You Have the Following

• Preferred Skills and Abilities: Microsoft Office.
• Preferred Education: 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.

Work Environment

Typical office environment. May involve some travel between office buildings and some/frequent out of town travel. Must have reliable transportation and be willing to travel, including occasional overnight stays, as required.

Our Comprehensive Benefits Package Includes The Following

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy‑related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email [e-mail] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case‑by‑case basis. We participate in E‑Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Veterans Welcome

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full‑time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.