Provider Network Consultant

Health Care Service Corporation; Chicago (IL); On-site; USD 54,000 - 122,000; Full time

Job summary

An established industry player is seeking a Provider Network Consultant to foster relationships within the health care sector. This role involves developing and maintaining cooperative working relationships with providers, ensuring adherence to contractual and financial requirements, and educating stakeholders. The ideal candidate will possess strong analytical and communication skills, along with a solid understanding of the health care industry. Join a purpose-driven organization that values professional development and offers a comprehensive benefits package to support your career and well-being.

Benefits

Health and wellness benefits

401(k) savings plan

Pension plan

Paid time off

Paid parental leave

Disability insurance

Tuition reimbursement

Employee assistance program

Paid holidays

Qualifications

• Bachelor’s degree or 4 years of experience in managed care required.
• 2+ years of health care administration experience preferred.

Responsibilities

• Develop and maintain relationships with contracting providers.
• Educate and train providers on contractual and financial requirements.

Skills

Interpersonal Skills

Analytical Skills

Presentation Skills

Communication Skills

Organizational Skills

Initiative

Ability to Work Independently

Education

Bachelor’s degree in health care or business administration

4 years work experience in a managed care environment

Tools

Microsoft Office

Claims Processing Systems

Job description

Provider Network Consultant page is loaded

Provider Network Consultant

Apply locations IL - Chicago time type Full time posted on Posted Yesterday job requisition id R0041883

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for developing and maintaining cooperative working relationships with the contracting provider community; educating, training, researching problems; and identifying trends and evaluating providers to ensure contractual and financial requirements are adhered to and performed. Ability and willingness to travel, including overnight stays.

Required Job Qualifications:

1. Bachelor’s degree in health care or business administration or a minimum of 4 years work experience in a managed care environment.
2. Minimum of 2 years of health care administration experience in clinical and financial settings, with direct provider communication experience.
3. Effective interpersonal, analytical, presentation and communication skills.
4. Knowledge of the health care industry and BCBSIL private business.
5. Ability and willingness to travel within assigned areas for responsibility, including overnight stays.
6. Extensive knowledge of contracts, applications, and products.
7. Demonstrated proficiency in provider reimbursement methods.
8. Working knowledge of claims processing systems.
9. Effective organizational and planning skills.
10. Ability to take initiative and work independently.
11. Demonstrated ability to meet deadlines and work well under pressure.
12. Working knowledge of software, including Microsoft Office.

Preferred Job Qualifications:

1. Knowledge of ICD-10, CPT, HCPCS and revenue codes.
2. COB (Coordination of Benefits) and overpayment knowledge.
3. Familiar with Medicare, Medicaid and Commercial payer rules.
4. Experience identifying and resolving complex claims issues and trends.
5. Proven ability to analyze root cause and recommend improvements.
6. Experience supporting cross-functional teams which include Provider Relations, Customer Service and Claims.
7. Strong verbal and written communication skills, especially in claims logic.
8. The ability to train staff on claims processes and workflows.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$54,800.00 - $121,100.00