Senior Provider Relations Coordinator

Health Care Service Corporation•Houston, TX

1d•$41,700 - $92,800•Hybrid

About The Position

HCSC is looking for a dynamic individual to join its Provider Relations team in HOUSTON TX! This position is responsible for providing support, as well as developing and maintaining cooperative working relationships with contracted providers, with supervision. The incumbent enhances provider ease of doing business with HCSC, as directed which includes issue tracking and resolution, educating, training, identifying trends and evaluating providers to ensure that contractual and financial requirements are adhered to and performed. This role serves as a key liaison between providers and internal teams, supporting provider onboarding, issue resolution, and ongoing engagement. Responsible for managing and strengthening relationships with healthcare providers, ensuring network satisfaction, compliance, and operational efficiency. This role is HYBRID/FLEX and requires in-office visibility three days per week, working from home the other two days. NOTE: relocation is not available, sponsorship will not be extended either now or in the future.

Requirements

Bachelor’s Degree OR four (4) years managed care operations experience handling independent work.
Effective verbal and written communications skills with ability to explain complex policies in a clear, provider-friendly way and providers understand policies, procedures, and reimbursement structures.
Strong organizational, planning and time management ability to manage multiple provider accounts and priorities.
Keen analytical skills to evaluate provider data to identify trends, issues, and improvement opportunities.
Ability to build and maintain strong, collaborative relationships with providers and office staff.
Possess an understanding of claims, billing, and reimbursement processes as well as PC proficiency to include Word, Outlook, PowerPoint and Excel as well as Workday.

Nice To Haves

Ability and willingness to travel within assigned territory, including overnight stays.
Experience with credentialing and provider lifecycle management.
Advanced Excel competency (i.e. pivot tables, vLookups, etc.).
Strong knowledge of FACETS, EPIC, HCFA/UB

Responsibilities

Develop knowledge of products, contract requirements, legislative requirements, and general relationship management in order to effectively support relationship between HCSC and Providers.
Provide support to Provider Relations Department by researching issues and inquiries, learning processes, systems, and internal operations to resolve issues.
Establish and maintain relationships within assigned territory for physicians, physician groups and facilities.
Ensure appropriate provider services including working across departments to resolve issues.
Participate in collection of network applications and required credentials process, troubleshoot delayed response, and expedite urgent requests to support network deficiencies.
Assist with delegated credentialing oversight activities.
Ensure assigned providers are informed when changes occur in policies and procedures and provide appropriate education/in-service.
Coordinate orientation, training and continuing policy education to provider office staff, billing staff and referral/precertification areas.
Respond to provider inquiries in an effective and timely manner and coordinate resolution to inquiries.
With supervision, work closely with Health Care Finance, Full-Service Units, Utilization Management, Medical, Delegation Oversight (practitioners only), Core Credentialing, Provider Automation and other divisions within the company.
Establish and maintain relationships with assigned providers through personal visits, correspondence and telephone calls.
Respond to provider inquiries in an effective and timely manner and coordinate claims resolution to payment problems.
Responsible for maintaining an up-to-date tracker of provider concerns and pain points, independently and/or with guidance.
Participate in discussions around resolutions.
Prepare for and lead, and/or assist with, internal and external meetings to assure and enhance provider success (e.g.: PowerPoint decks, Excel, analytics, presentation skills).
Maintains a functional level of knowledge regarding all Provider Relations systems (e.g.: GUI, PPW, SalesForce, etc.)
Ensure all expenditures comply with corporate and divisional expense guidelines.
Communicate and interact effectively and professionally with co-workers, management, customers, etc.
Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
Other duties as assigned by leadership
Maintain complete confidentiality of company business.
Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
Other duties as assigned by leadership