Provider Relations Consultant

BlueCross BlueShield of South Carolina•Columbia, SC

1d•Onsite

About The Position

BlueCross BlueShield of South Carolina is hiring a Provider Relations Consultant to establish and maintain positive relationships with network hospitals, physician and dental practices, and their representatives. The consultant serves as a point of contact for provider problems and issues, responds to difficult or non-routine concerns involving network contracts, reimbursement methodologies, benefit structures, medical policies, and administrative policies, identifies underlying causes, recommends changes, coordinates problem-resolution meetings, and provides management with feedback. The consultant creates educational materials and educates providers on the company’s lines of business and products. Education may cover coverage, website navigation, utilization statistics, and documentation requirements, using written advisories, reports, letters, bulletins, telephone contacts, and in-person visits. The consultant records provider contacts in the provider education database; trains providers on electronic filing, accurate claims filing, contract requirements, and reimbursements; conducts workshops and speaks at provider events; and prepares reports for management. This is a full-time, onsite role at 4101 Percival Road, Columbia, South Carolina, in a typical office environment. The schedule is Monday through Friday, 40 hours per week, with an eight-hour shift during normal business hours of 8:00 a.m. to 5:00 p.m. Occasional overtime may be needed. Travel between buildings and other work-related travel, including some overnight stays, may be required. The position is not eligible for current or future sponsorship.

Requirements

Bachelor’s degree, or an equivalent 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 networks, claims management, or a combination of these; two of the five 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 knowledge, including mathematical and statistical concepts.
Ability to handle confidential or sensitive information discreetly.
Ability to lead and motivate employees.
Must be willing to travel and have reliable transportation; some overnight stays are required.
Microsoft Office skills.

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 and respond to difficult or non-routine concerns about contracts, reimbursement, benefits, medical policies, and administrative policies.
Determine underlying causes of provider issues and recommend changes to address them.
Coordinate or conduct meetings to resolve problems and provide management with feedback.
Create provider educational materials, including webinars and brochures, and educate providers on company lines of business and products.
Explain coverage, website navigation, utilization statistics, and documentation requirements through written communications, reports, telephone contacts, and in-person visits.
Document provider contacts and communications in the provider education database.
Train providers on electronic filing, reducing duplicate or incorrect claims, contract requirements, and reimbursement.
Conduct workshops and speak at conferences, meetings, and conventions at the request of provider groups.
Prepare and submit reports to management.