Provider Network Consultant

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

Job summary

Join a purpose-driven company dedicated to investing in your professional development! This hybrid role offers the opportunity to develop and maintain relationships within the health care provider community. You will educate and train providers while ensuring compliance with contractual and financial requirements. Ideal candidates will possess strong analytical and communication skills, along with a bachelor's degree or relevant experience in managed care. Be part of a team that values diversity and fosters a welcoming environment, where your unique differences are respected and valued. This role is perfect for those who thrive in a dynamic and collaborative setting.

Qualifications

• Bachelor's degree or 4 years experience in managed care required.
• 2+ years in health care administration with provider communication.

Responsibilities

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

Skills

Interpersonal Skills

Analytical Skills

Communication Skills

Knowledge of Health Care Industry

Problem-Solving Skills

Organizational Skills

Training Skills

Ability to Work Independently

Education

Bachelor's Degree in Health Care or Business Administration

4 Years Work Experience in Managed Care

Tools

Microsoft Office

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.

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.

This is a Flex (Hybrid) role: 3 days in office; 2 days remote

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. Knowledge of ICD-10, CPT, HCPCS and revenue codes.
11. COB (Coordination of Benefits) and overpayment knowledge.
12. Familiar with Medicare, Medicaid and Commercial payer rules.
13. Experience identifying and resolving complex claims issues and trends.
14. Proven ability to analyze root cause and recommend improvements.
15. Experience supporting cross functional teams which include Provider Relations, Customer Service and Claims.
16. Strong verbal and written communication skills, especially in claims logic.
17. The ability to train staff on claims processes and workflows.
18. Ability to take initiative and work independently.
19. Demonstrated ability to meet deadlines and work well under pressure.
20. 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