Provider Network Consultant

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

Job summary

An established industry player is seeking a dedicated professional to enhance relationships with the provider community. This hybrid role offers the opportunity to educate and train providers, ensuring adherence to contractual and financial requirements. With a focus on professional development, you will engage in meaningful work that impacts the health care landscape. If you are passionate about improving health care services and thrive in a collaborative environment, this position is perfect for you.

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 in health care or business administration required.
• Minimum 2 years of health care administration experience.

Responsibilities

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

Skills

Interpersonal Skills

Analytical Skills

Presentation Skills

Communication Skills

Provider Reimbursement Methods

Claims Processing Knowledge

Contract Knowledge

Problem-Solving

Education

Bachelor's Degree in Health Care or Business Administration

4+ years in Managed Care Environment

Tools

Microsoft Office

Job description

At HCSC, our employees are the cornerstone of our business and the foundation of 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 invests 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.

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

Preferred Job Qualifications:

• Knowledge of ICD-10, CPT, HCPCS, and revenue codes.
• COB (Coordination of Benefits) and overpayment knowledge.
• Familiarity with Medicare, Medicaid, and Commercial payer rules.
• Experience in identifying and resolving complex claims issues and trends.
• Proven ability to analyze root causes and recommend improvements.
• Experience supporting cross-functional teams including Provider Relations, Customer Service, and Claims.
• Strong verbal and written communication skills, especially in claims logic.
• 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, to other incentives, we offer a robust total rewards package. Learn more at https://careers.hcsc.com/totalrewards.

The offered compensation varies based on skills, education, and experience. This role aligns with an annual incentive bonus plan, subject to plan terms and conditions.

HCSC Employment Statement:

We are an Equal Opportunity Employer dedicated to creating a welcoming environment that respects and values the differences of our employees. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or other legally protected characteristics.

Base Pay Range

$54,800.00 - $121,100.00