Provider Relations Consultant - Healthcare Networks

Blue Cross Blue Shield; Columbia (SC); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health plans

Dental coverage

Vision coverage

401k

Life Insurance

Paid Time Off

On-site cafeterias

Fitness centers

Education Assistance

Service Recognition

Discount programs

Job summary

BlueCross BlueShield of South Carolina is seeking a Provider Network Specialist to establish and maintain positive relationships with network hospitals, physicians, and dental practices. You will respond to complex issues related to contracts, reimbursement, policies, and coding, and coordinate problem-solving meetings.

You will educate providers across Medicare, state programs, and corporate products, and document interactions in the education database.

Qualifications

• Knowledge/understanding of automated medical management systems and claims processing systems.
• Ability to work independently, prioritize effectively, and make sound decisions.
• 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.

Responsibilities

• 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.

Skills

Healthcare administration

Customer service

Analytical thinking

Decision making

Presentation skills

Negotiation

Microsoft Office

Data interpretation

Education

Bachelor's degree equivalency

RN licensure

LPN licensure

Tools

Microsoft Access

Job description

BlueCross BlueShield of South Carolina is seeking a Provider Network Specialist to establish and maintain positive relationships with network hospitals, physicians, and dental practices. You will respond to complex issues related to contracts, reimbursement, policies, and coding, and coordinate problem-solving meetings.

You will educate providers across Medicare, state programs, and corporate products, and document interactions in the education database.