Consultant, Provider Relations

Blue Cross Blue Shield; Columbia (SC); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health plans

Dental coverage

Vision coverage

401k

Life Insurance

Paid Time Off

On-site cafeterias

Fitness centers

Education Assistance

Service Recognition

Discount programs

Job summary

BlueCross BlueShield of South Carolina is seeking a Provider Network Specialist to establish and maintain positive relationships with network hospitals, physicians, and dental practices. You will respond to complex issues related to contracts, reimbursement, policies, and coding, and coordinate problem-solving meetings.

You will educate providers across Medicare, state programs, and corporate products, and document interactions in the education database.

Qualifications

• Knowledge/understanding of automated medical management systems and claims processing systems.
• Ability to work independently, prioritize effectively, and make sound decisions.
• 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.

Responsibilities

• 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.

Skills

Healthcare administration

Customer service

Analytical thinking

Decision making

Presentation skills

Negotiation

Microsoft Office

Data interpretation

Education

Bachelor's degree equivalency

RN licensure

LPN licensure

Tools

Microsoft Access

Job description

SummaryEstablishes 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.DescriptionLogistics: BlueCross BlueShield of South Carolina - About Us | BlueCross BlueShield of South CarolinaLocation: 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'sDegree 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 OfficeWork 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 Comprehensive Benefits Package Includes The Following:We offer our employees great benefits and rewards. You will be eligible to participate in our benefits program the first of the month following 28 days of employment.· 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 moreWhat 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.What to Expect Next:After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.Equal Employment Opportunity StatementBlueCross 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. Here's more information .Some states have required notifications. Here's more information .