Senior r Provider Network Representative

Health Care Service Corporation; Austin (TX); On-site; USD 56,000 - 124,000; Full time

Job summary

Health Care Service Corporation is seeking a Provider Relations leader to plan and direct recruitment and contracting with physicians and networks. You will educate providers on plan benefits, policies, and reimbursement processes, and act as a liaison with internal teams to resolve issues.

This field-based role in the Austin, Texas market requires travel to provider offices, strong negotiation skills, and the ability to train new staff.

Qualifications

• Bachelor's degree in business or 6 years leadership experience.
• 4 years’ experience in claims, customer service, provider environment.
• 3 years in provider relations, contracting and reimbursement.
• Ability to negotiate and contract with healthcare providers.
• MS Office proficiency; strong organizational and planning skills.

Responsibilities

• Plan and direct provider recruitment and contracting activities.
• Educate providers on plan benefits, policies, and reimbursement processes.
• Provide ongoing provider service and support; resolve complex issues.
• Serve as liaison between providers and internal business partners.
• Provide training to new and existing network staff.

Skills

Negotiation

Contracting

Planning

Multi-tasking

Travel readiness

MS Office

Education

Bachelor's degree in business

Leadership experience

Tools

BCBSTX claims systems

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.

Job Summary

This position is responsible for planning and directing provider recruitment and contracting activities; educating providers on plan benefits, policies, procedures, and reimbursement processes; providing ongoing provider service and support; resolving complex provider issues; serving as a liaison between providers and internal business partners; and providing training to new and existing network staff.

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:

• Demonstrated success building and maintaining relationships with physician groups, hospitals, and provider leadership.
• Experience conducting provider education, training, and face-to-face consultations.
• Experience resolving complex claims, reimbursement, and payment issues for providers.
• 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

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

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.

Base Pay Range

$55,900.00 - $123,500.00

Exact compensation may vary based on skills, experience, and location.