Healthcare Provider Relations Specialist

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

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.