Provider Network Consultant

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

Job summary

Join a purpose-driven company that values its employees and fosters professional growth. This role involves developing relationships with providers, ensuring compliance with contractual requirements, and effectively communicating within the health care industry. You will play a crucial part in educating and training providers, while also analyzing trends and resolving complex claims issues. With a commitment to employee development and a supportive work environment, this position offers a rewarding opportunity to make a significant impact in the health care sector.

Qualifications

• 2+ years of health care administration experience in clinical and financial settings.
• Extensive knowledge of contracts, applications, and products.

Responsibilities

• Develop and maintain relationships with the contracting provider community.
• Educate and train providers while evaluating trends and compliance.

Skills

Interpersonal Skills

Analytical Skills

Presentation Skills

Communication Skills

Organizational Skills

Initiative

Ability to Work Independently

Ability to Meet Deadlines

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

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.

Position Overview

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.

Compensation

$54,800.00 - $121,100.00. Exact compensation may vary based on skills, experience, and location.

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.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards.