Consultant, Provider Relations

001 BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Subsidized health plans

401k with company match

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking a Provider Relations professional to establish and sustain positive relationships with network hospitals, physicians, and dental practices. You will be the primary contact for provider issues, address complex reimbursement and policy challenges, and drive problem resolution through meetings and targeted education.

In this role you will educate providers on Medicare Advantage, BlueChoice, FEP, state programs, and Exchanges, and support management

Qualifications

• Bachelor's degree equivalence: four years of job-related experience or an Associate’s degree with two years of job-related experience.
• Five years of healthcare, medical affairs, provider network, claims management, or a combination of these.
• Two of the five years must be with direct health plan/payer programs.

Responsibilities

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

Skills

Provider relations

Problem solving

Communication skills

Microsoft Office

Education

Bachelor's degree or equivalent

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 join BlueCross BlueShield of South Carolina?

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.

Sponsorship

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

Description Logistics

• 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

• 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.

Preferred

• 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.

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 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.