Consultant, Provider Relations

BlueCross BlueShield of South Carolina•Columbia, SC

5d•Onsite

About The Position

Establishes and maintains positive relationships with network hospitals, physician and/or dental practices, and their representatives. Serves as point of contact for provider problems/issues. Responds to non-routine or difficult problems/issues related to network contracts, reimbursement methodologies, benefit structure, medical policies, administrative policies, etc. Determines underlying cause(s) of problems and recommends changes to alleviate problems/issues. Coordinates/conducts meeting for problem resolution. Provides management with feedback on problems/issues. Creates educational materials (webinars, brochures, etc.) for providers. Educates providers on all lines of business such as Medicare Advantage, BlueChoice, FEP, State, as well as our corporate products, including the Exchanges. Explains coverage, website navigation, utilization statistics, and documentation requirements by use of written advisories, reports, letters, bulletins, telephone contacts and in person visits. Documents all provider contacts and communications in the provider education database. Conducts training in the following areas: electronic filing, reducing duplicate claims filings/incorrect claims filing, contract requirements, and reimbursements. Conducts workshops and speaks at conferences/meetings/conventions, etc. as requested by hospitals/physician and/or dental practice groups. Prepares/submits various reports to management.

Requirements

Bachelor's Degree equivalency: 4 years job related work experience or Associate's and 2 years job related work experience
5 years of healthcare, medical affairs, provider network, claims management, or combination of these.
2 of the 5 years must have been with direct health plan/payer programs.

Nice To Haves

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

Responsibilities

Serves as point of contact for provider problems/issues.
Responds to non-routine or difficult problems/issues related to network contracts, reimbursement methodologies, benefit structure, medical policies, administrative policies, etc.
Determines underlying cause(s) of problems and recommends changes to alleviate problems/issues.
Coordinates/conducts meeting for problem resolution.
Provides management with feedback on problems/issues.
Creates educational materials (webinars, brochures, etc.) for providers.
Educates providers on all lines of business such as Medicare Advantage, BlueChoice, FEP, State, as well as our corporate products, including the Exchanges.
Explains coverage, website navigation, utilization statistics, and documentation requirements by use of written advisories, reports, letters, bulletins, telephone contacts and in person visits.
Documents all provider contacts and communications in the provider education database.
Conducts training in the following areas: electronic filing, reducing duplicate claims filings/incorrect claims filing, contract requirements, and reimbursements.
Conducts workshops and speaks at conferences/meetings/conventions, etc. as requested by hospitals/physician and/or dental practice groups.
Prepares/submits various reports to management.