Provider Relations Consultant

BlueCross and BlueShield of South Carolina

Columbia (SC)

On-site

USD 75,000 - 105,000

Full time

3 days ago

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Benefits offered by this job

Health benefits

401(k) plan

Life Insurance

Paid Time Off

On-site facilities

Education Assistance

Service Recognition

Discount programs

Job summary

BlueCross BlueShield of South Carolina is hiring a Provider Relations Consultant to build and maintain positive relationships with network hospitals and practices. The role serves as the point of contact for provider issues, educates on contracts and policies, and prepares reports for management.

The position requires a Bachelor's degree and 5 years of healthcare/provider network experience, with 2 years in direct health plan programs. Office-based, full-time in Columbia, SC.

Qualifications

Bachelor's degree required.
Five years of healthcare or provider network experience.
Two years with direct health plan/payer programs preferred.

Responsibilities

Serve as main contact for provider issues related to contracts, reimbursement, benefits, and policies.
Educate providers on lines of business and policy requirements; document contacts and communications.
Conduct training on electronic filing, claims, and reimbursements.
Conduct workshops and speak at conferences as requested by hospitals or provider groups.
Prepare and submit reports to management.

Skills

Healthcare exp

Provider network

Claims management

Customer service

Analytical thinking

Microsoft Office

Education

Bachelor's degree

4 years related exp

Tools

Microsoft Office

Job description

Position Purpose:

We are currently hiring a Provider Relations Consultant to join BlueCross BlueShield of South Carolina. As a Provider Relations Consultant, you will establish and maintain positive relationships with network hospitals, physician and/or dental practices, and their representatives. Serves as point of contact for provider problems/issues. Responds to non-routine or difficult problems/issues related to network contracts, reimbursement methodologies, benefit structure, medical policies, administrative policies, etc. Determines underlying cause(s) of problems and recommends changes to alleviate problems/issues. Coordinates/conducts meeting for problem resolution. Provides management with feedback on problems/issues.

Logistics:

BlueCross BlueShield of South Carolina - About Us | BlueCross BlueShield of South Carolina

Location:

This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM - 5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 4101 Percival Road Columbia, SC 29229.

Sponsorship:

This position is not eligible for sponsorship now or in the future.

What You'll Do:

Serves as point of contact for provider problems/issues. Responds to non-routine or difficult problems/issues related to network contracts, reimbursement methodologies, benefit structure, medical policies, administrative policies, etc. Determines underlying cause(s) of problems and recommends changes to alleviate problems/issues. Coordinates/conducts meeting for problem resolution. Provides management with feedback on problems/issues.
Creates educational materials (webinars, brochures, etc.) for providers. Educates providers on all lines of business such as Medicare Advantage, BlueChoice, FEP, State, as well as our corporate products, including the Exchanges. Explains coverage, website navigation, utilization statistics, and documentation requirements by use of written advisories, reports, letters, bulletins, telephone contacts and in person visits. Documents all provider contacts and communications in the provider education database.
Conducts training in the following areas: electronic filing, reducing duplicate claims filings/incorrect claims filing, contract requirements, and reimbursements.
Conducts workshops and speaks at conferences/meetings/conventions, etc. as requested by hospitals/physician and/or dental practice groups.
Prepares/submits various reports to management.

To Qualify for This Position, You'll Need the Following:

Required Education: Bachelor's
Degree Equivalency: Four (4) years job related work experience or Associate's and two (2) years job related work experience.
Required Work Experience: Five (5) years of healthcare, medical affairs, provider network, claims management, or combination of these. Two (2) of the Five (5) years must have been with direct health plan/payer programs.
Required Skills and Abilities: Knowledge/understanding of automated medical management systems and claims processing systems. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Basic business math and knowledge of mathematical/statistical concepts. Ability to handle confidential or sensitive information with discretion. Ability to lead and motivate employees.
Required Software and Tools: Microsoft Office
Work Environment: Typical office environment. May involve some travel between buildings. Must be willing to travel and have reliable transportation. Some overnight stay is required.

We Prefer That You Have The Following:

Bachelor's degree-in Business Administration, Business Management, Healthcare Administration, Marketing, or other job related field.
Preferred Work Experience: 3 years-of previous supervisory or management experience.
Preferred Skills and Abilities: Knowledge of marketing and contracting.
Preferred Software and Other Tools: Working knowledge of Microsoft Access or other database software.
Preferred Licenses and Certificates: Active RN licensure in state hired or active LPN licensure in state hired.

Our Comprehensive Benefits Package Includes The Following:

We offer our employees great benefits and rewards. You will be eligible to participate in our benefits program the first of the month following 28 days of employment.