Provider Network Consultant

Health Care Service Corporation•Chicago, IL

1d•Hybrid

About The Position

This position is responsible for developing and maintaining cooperative working relationships with the contracting provider community; educating, training, researching problems; and identifying trends and evaluating providers to ensure contractual and financial requirements are adhered to and performed. Ability and willingness to travel, including overnight stays.

Requirements

Bachelor’s degree in health care or business administration or a minimum of 4 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
Knowledge of the health care industry and BCBSIL private business
Ability and willingness to travel within assigned areas for responsibility, including overnight stays
Extensive knowledge of contracts, applications, and products
Demonstrated proficiency in provider reimbursement methods
Working knowledge of claims processing systems
Effective organizational and planning skills
Ability to take initiative and work independently
Demonstrated ability to meet deadlines and work well under pressure
Working knowledge of software, including Microsoft Office

Nice To Haves

Provider facing experience
Claims processing experience is a plus
Familiar with Government contracts i.e. regulatory/compliance
Knowledge of Commercial line of business
Project management experience
Self starter

Responsibilities

Developing and maintaining cooperative working relationships with the contracting provider community
Educating and training providers
Researching problems
Identifying trends
Evaluating providers to ensure contractual and financial requirements are adhered to and performed