Provider Relations Representative

Health Care Service Corporation; Jacksonville (IL); Hybrid; USD 63,000 - 114,000; Full time

Benefits offered by this job

Flex in-office 3 days / 2 days WFH

Job summary

HCSC is seeking a Provider Relations Specialist to support contracted providers and streamline interactions with HCSC on a national scale. The role focuses on issue tracking, education, training, and evaluating providers to ensure contractual and financial requirements are met, with emphasis on reliable service and operational excellence.

The position requires healthcare administration experience, knowledge of Medicaid/Medicare processes, and the ability to travel.

Qualifications

• Bachelor’s degree and 3+ years in managed care, or 5+ years in a managed care environment.
• 2+ years of health care administration experience with direct provider communication.
• Knowledge of Medicaid and Medicare processes, including provider education and operational support.
• Strong interpersonal, analytical, presentation and communication skills.
• Willingness to travel, including overnight stays.
• Knowledge of contracts, products and provider reimbursement methods.
• Experience with claims processing systems.
• Proficient in Word, Excel and PowerPoint.

Responsibilities

• Support providers on medical insurance and claims-related inquiries.
• Develop and maintain cooperative relationships with contracted providers.
• Facilitate and enhance provider’s ease of doing business with HCSC.
• Track issues, provide education and training, identify trends and evaluate providers for compliance.

Skills

Interpersonal skills

Analytical skills

Presentation skills

Communication skills

Training skills

Team collaboration

Ability to take initiative

Deadline management

Education

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

PowerPoint

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 providing support, as well as developing and maintaining cooperative working relationships with contracted providers. Responsible for facilitating and enhancing provider’s ease of doing business with HCSC. This includes issue tracking and resolution, education, training, identifying trends and evaluating providers to ensure that all contractual and financial requirements are adhered to and performed. Supports providers on medical insurance and claims-related inquiries, leverages knowledge of Medicaid and Medicare business processes to resolve issues and provide education, and addresses provider requests across a national scope while promoting consistent service and operational excellence.

Required Job Qualifications

• Bachelor’s degree AND 3 years of work experience in managed care, OR a minimum of 5 years’ work experience in a managed care environment.
• Minimum of 2 years of health care administration experience in clinical and financial settings, with direct provider communication experience.
• Demonstrated knowledge of Medicaid and Medicare business processes, including provider education and operational support.
• Effective interpersonal, analytical, presentation and communication skills.
• Knowledge of the health care industry.
• Ability and willingness to travel within assigned areas for responsibility, including overnight stays.
• Knowledge of contracts, applications, and products.
• Understanding of provider reimbursement methods.
• Working knowledge of claims processing systems.
• Effective organizational and planning skills.
• Analytical skills.
• Ability to take initiative and work independently.
• Demonstrated ability to meet deadlines and work well under pressure.
• Clear and concise interpersonal, verbal and written communication skills.
• Collaboration skills resulting in business/process improvements/changes.
• PC experience and skills to include Word, Excel, PowerPoint, etc.
• Facilitation, presentation and analytical skills.

Preferred Job Qualifications

• 3 years of experience supporting medical insurance operations, claims handling, and provider issue resolution.
• Demonstrated knowledge of Medicaid and Medicare business processes, including provider education and operational support.
• Experience researching, tracking, and resolving provider inquiries while ensuring a high level of service and responsiveness.
• Proven ability to develop and maintain strong relationships with contracted providers and key stakeholders.
• Experience identifying trends, resolving escalated issues, and recommending process improvements.
• Knowledge of contractual and financial requirements related to provider network operations.
• Experience supporting provider requests across multiple markets or a national provider network environment.
• Strong communication and training skills with the ability to educate providers on policies, processes, and business requirements.

Sponsorship is not available.

This is a Flex role that requires 3 days in office and 2 days WFH.

#INAK

Compensation: $63,300.00 - $114,300.00

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. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

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