Consultant, Provider Relations

BlueCross BlueShield of South Carolina•Columbia, SC

1d•Onsite

About The Position

Establishes and maintains positive relationships with network hospitals, physician and dental practices, and their representatives. Serves as a point of contact for provider problems and issues, responding to non-routine or difficult matters related to network contracts, reimbursement methodologies, benefit structures, medical and administrative policies, and other topics. Identifies underlying causes, recommends changes to resolve issues, coordinates or conducts problem-resolution meetings, and provides management with feedback. Creates educational materials for providers and educates them about all lines of business, including Medicare Advantage, BlueChoice, FEP, State, corporate products, and Exchanges. Explains coverage, website navigation, utilization statistics, and documentation requirements through written and verbal communications and in-person visits. Documents provider contacts and communications in the provider education database. Conducts training on electronic filing, claim accuracy, contract requirements, and reimbursements; conducts workshops and speaks at provider-group events as requested; and prepares reports for management. This is a full-time, onsite position at 4101 Percival Road, Columbia, South Carolina. The schedule is Monday through Friday, 40 hours per week, on an eight-hour shift during normal business hours of 8:00 a.m. to 5:00 p.m. Occasional overtime may be necessary. The role may require travel between buildings and other travel, including some overnight stays. Reliable transportation is required. The position is not eligible for current or future sponsorship.

Requirements

Bachelor's degree, or equivalent experience consisting of four years of job-related work experience or an associate degree plus two years of job-related work experience.
Five years of experience in healthcare, medical affairs, provider network, claims management, or a combination of these; at least two years must be with direct health plan or payer programs.
Knowledge of automated medical management systems and claims processing systems.
Ability to work independently, prioritize effectively, and make sound decisions.
Good judgment, customer service, organizational, and presentation skills.
Ability to persuade, negotiate, or influence others.
Analytical or critical-thinking skills and basic business math and knowledge of mathematical or statistical concepts.
Ability to handle confidential or sensitive information with discretion.
Ability to lead and motivate employees.
Proficiency with Microsoft Office.
Willingness to travel, reliable transportation, and ability to stay overnight when required.

Nice To Haves

Bachelor's degree in Business Administration, Business Management, Healthcare Administration, Marketing, or another job-related field.
Three years of previous supervisory or management experience.
Knowledge of marketing and contracting.
Working knowledge of Microsoft Access or other database software.
Active RN or LPN licensure in the state of hire.

Responsibilities

Establish and maintain positive relationships with network hospitals, physician and dental practices, and their representatives.
Serve as the point of contact for provider problems and issues, including difficult or non-routine issues involving contracts, reimbursement, benefits, and policies.
Determine the underlying causes of provider issues and recommend changes to resolve them.
Coordinate or conduct meetings to resolve provider problems and provide management with feedback.
Create educational materials for providers, such as webinars and brochures.
Educate providers about the company's lines of business and explain coverage, website navigation, utilization statistics, and documentation requirements.
Document provider contacts and communications in the provider education database.
Conduct training on electronic filing, avoiding duplicate or incorrect claims, contract requirements, and reimbursements.
Conduct workshops and speak at conferences, meetings, and conventions at the request of provider groups.
Prepare and submit reports to management.