Senior Provider Relations Representative - Remote

HCSC Group; Austin (TX); Hybrid; USD 63,000 - 114,000; Full time

Job summary

HCSC in Austin, TX is seeking a Provider Relations Specialist to develop and maintain strong relationships with providers, support network performance, and serve as a primary escalation point for provider concerns. You will educate and train providers, identify trends, and help ensure financial and operational requirements are met.

The role requires 4 years of claims or healthcare environment experience, 3 years in provider relations (contracting and reimbursement), strong negotiation and

Qualifications

• Bachelor’s degree or 6 years leadership experience.
• 4 years’ experience in claims, customer service, physician office or hospital or healthcare environment.
• 3 years’ experience in provider relations, including contracting and reimbursement issues.
• Ability to negotiate and contract with healthcare providers.

Responsibilities

• Develop and maintain cooperative working relationships with providers to support network performance.
• Serve as a resource and escalation point for provider concerns, issue tracking and resolution.
• Educate and train providers, identify trends, and evaluate provider performance to meet requirements.
• Travel within assigned areas as needed, including overnight stays.

Skills

Negotiation

Provider relations

Communication

Travel readiness

Education

Bachelor’s degree or 6 years leadership experience

Tools

Microsoft Office

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 providers while facilitating and enhancing provider ease of doing business with HCSC. This includes establishing and maintaining provider relationships to support network performance, serving as a resource and point of escalation for provider concerns, issue tracking and resolution, educating and training providers, identifying trends, and evaluating provider performance to ensure operational and financial requirements are met.

Required Job Qualifications:

• Bachelor’s degree in business OR 6 years leadership experience.
• 4 years’ experience in claims, customer service, physician office or hospital or healthcare environment.
• 3 years’ experience in a position which requires in-depth physician/provider relations, including but not limited to, contracting and reimbursement issues.
• Ability to negotiate and contract with healthcare providers.
• Platform skills; organizational and planning skills; and ability to take initiative and work independently.
• Ability to multi-task; meet deadlines and work well under pressure.
• Ability and willingness to travel within assigned areas of responsibility, including overnight stays.
• PC proficiency to include Microsoft Office

Preferred 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.
• Effective interpersonal, analytical, presentation and communication skills.
• 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.
• Demonstrated success building and maintaining relationships with physician groups, hospitals, and provider leadership.
• Experience conducting provider education, training, and face-to-face consultations. .
• Extensive Medicaid and Medicare Advantage experience.
• Knowledge of healthcare contracting, reimbursement methodologies, and managed care operations.
• Prior territory management experience.
• Knowledge of BCBSTX claims processing systems.

Additional Details

Client-site Location: This is a field-based position in the Austin Texas market that requires provider office visits.

Sponsorship: Sponsorship is not available

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