Provider Relations Representative

Health Care Service Corporation; Springfield (IL); Hybrid; USD 63.000 - 114.000; Vollzeit

Zusammenfassung

HCSC is seeking a provider relations professional to help providers navigate our network, improve processes, and ensure contract and financial requirements are met. This role emphasizes education, issue resolution, and relationship management across a national scope.

Ideal candidates will have a bachelor’s degree and substantial managed care experience, with strong analytical and communication skills, and will be willing to travel as needed. This is a hybrid role with in-office and remote days.

Qualifikationen

• Bachelor’s degree required; 3 years in managed care OR 5 years in managed care environment.

Aufgaben

• Provide support and develop relationships with contracted providers.
• Facilitate and improve providers' ease of doing business with HCSC.
• Track issues and resolve with education and training as needed.
• Identify trends and evaluate providers to meet contractual and financial requirements.
• Support providers on medical insurance and claims inquiries; apply Medicaid/Medicare processes to resolve issues.

Kenntnisse

Managed care

Provider relations

Education/training

Analytical skills

Communication skills

Travel flexibility

Contracts knowledge

Claims systems

Ausbildung

Bachelor's degree

Tools

Word

Excel

PowerPoint

Jobbeschreibung

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 degreeAND3years of work experience in managed care, OR aminimum of5years’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,presentationand 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 ofprovider 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,verbaland written communication skills.

• Collaborationskills resulting in business/process improvements/changes.

• PC experience and skillsto includeWord, Excel, PowerPoint, etc.

• Facilitation,presentationand 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.

#LI-Hybrid

#LI-KW1

#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