Consultant, Provider Relations

ourhrconnect; Columbia (SC); On-site; USD 80,000 - 110,000; Full time

Benefits offered by this job

Health plans

401k with match

Life Insurance

Paid time off

On-site facilities

Education assistance

Service recognition

Discount programs

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 resolve non-routine issues, coordinate problem resolution meetings, and provide feedback to management.

The role requires a Bachelor's degree, 5 years in healthcare/provider network roles, and 2 years in payer programs. On-site at Columbia, SC with standard hours and some travel.

Qualifications

• Bachelor's degree required.
• 5 years of healthcare, medical affairs, provider network, claims management, or combination.
• 2 of the 5 years must be with direct health plan/payer programs.

Responsibilities

• Serve as primary contact for provider problems and issues.
• Educate providers on lines of business and coverage through materials and communications.
• Conduct training on electronic filing, claims, and contract requirements.
• Lead workshops and speak at conferences as requested.
• Prepare and submit management reports.

Skills

Microsoft Office

Marketing knowledge

Contracting knowledge

Travel willingness

Education

Bachelor's degree

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 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.

Logistics

BlueCross BlueShield of South Carolina - About Us | BlueCross BlueShield of South Carolina

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

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

• 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

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits 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 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.

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 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 disabilitiesand 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 moreinformation.

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