Provider Relations Representative

HCSC Markets; Springfield (IL); Hybrid; USD 63,000 - 114,000; Full time

Benefits offered by this job

Hybrid work schedule

Job summary

HCSC in Illinois seeks a provider data and credentialing specialist responsible for contracting, credentialing, and maintaining professional provider data to support marketing, membership and network contracting across all lines of business. Building strong relations with the provider community and leading data integrity initiatives are essential parts of the role.

This hybrid/flex position requires in-office visibility three days per week, with work-from-home the other two.

Qualifications

• Bachelor’s degree required with 3+ years in managed care or 5+ years in managed care environment.
• Minimum 2 years of health care administration experience with direct provider communication.
• Strong interpersonal, analytical, presentation and communication skills.
• Knowledge of the health care industry and provider reimbursement methods.

Responsibilities

• Contracting, credentialing, and maintenance of provider data across lines of business.
• Support marketing, membership and network contracting efforts.
• Build relations with the provider community and lead data integrity initiatives.
• Provide training and education to nearly all Blue Cross contracted providers.

Skills

Interpersonal skills

Analytical skills

Presentation skills

Communication skills

Time management

Education

Bachelor's degree

Tools

Word

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 the contracting, credentialing, and maintenance of professional provider data to support marketing, membership and network contracting across all lines of business; building relations with the provider community is an important part of this role. Responsibilities include promoting high-quality initiatives to support data integrity; accepting ownership and leading highly specialized operational and customer support duties that require independent initiative. This role includes participating in internal provider meetings and work groups, researching problems related to provider credentialing, data and network participation. Incumbent also provides training and education to all Blue Cross contracted providers including, but not limited to hospitals, physicians, free-standing surgery centers, free standing substance abuse facilities, free standing psych facilities, VA hospitals, and all other allied professional providers.

NOTE: This role is HYBRID/FLEX and requires in-office visibility three days per week, working from home the other two days. Relocation is not available; sponsorship will not be extended either now or in the future.

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.

• 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

• Experience analyzing provider performance, utilization, or operational metrics and translating findings into actionable recommendations for providers and internal stakeholders.
• Experience supporting provider network initiatives, including provider onboarding, network expansion, value-based programs, or provider engagement strategies.
• Demonstrated success managing complex, multi-department issue resolution efforts requiring coordination across operations, claims, network management, and other business areas.
• Experience working with provider-facing reporting tools, dashboards, and data analysis to identify trends, monitor performance, and support decision-making.
• Knowledge of physician practice operations, revenue cycle management, or healthcare office workflows, including an understanding of operational challenges impacting provider performance and satisfaction.
• Advanced level of Excel fluency (i.e. pivot tables, data validation, handling large data sets)
• Strong familiarity with claims, billing, and coding basics (CPT, ICD-10 helpful)
• CRM or provider management systems knowledge
• Affiliation with IAMHP (Illinois Association of Medicaid Health Plans)
• Experience working with government agencies, legislative and advocacy groups

NOTE: This role is HYBRID/FLEX and requires in-office visibility three days per week, working from home the other two days. Relocation is not available; sponsorship will not be extended either now or in the future.

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.