Provider Relations Coordinator -Remote in AZ

Blue Cross Blue Shield of Arizona•Phoenix, AZ

1d•Remote

About The Position

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. This position is Remote within the state of AZ only. This Remote work opportunity requires residency, and work to be performed, within the State of Arizona. The Provider Relations Coordinator (PRC) is the primary BCBSAZ point of contact for contracted providers and responsible for effectively and efficiently resolving all provider issues.

Requirements

1 year of experience in Healthcare field (Applies to All Levels)
High-School Diploma or GED in field of study (Applies to All Levels)
Valid Arizona Driver License (required only for employees who reside in Arizona), with an acceptable driving record (Applies to All Levels)
Intermediate PC proficiency (Applies to All Levels)
Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (Applies to All Levels)
Intermediate skill in word processing, spreadsheet and database software (Applies to All Levels)
Ability to present and interact at a professional level (Applies to All Levels)
Ability to problem solve (Applies to All Levels)
Maintain confidentiality and privacy (Applies to All Levels)
Ability to prioritize and manage work assignments and work independently (Applies to All Levels)
Knowledge necessary to analyze reports based on available data and then make decisions based on reported data (Applies to All Levels)
Capable of investigative and analytical research (Applies to All Levels)
Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards (Applies to All Levels)
Establish and maintain working relationships in a collaborative team environment (Applies to All Levels)
Identify root causes and initiate solutions (Applies to All Levels)

Nice To Haves

2 years of experience in healthcare field, working with providers (Applies to All Levels)
Associate's Degree in field of study (Applies to All Levels)
Advanced skill in word processing, spreadsheet and database software (Applies to All Levels)
Knowledge of provider reimbursement methodologies contracts and networks (Applies to All Levels )
Knowledge of claims payment systems and ability to perform preliminary claims research (Applies to All Levels)

Responsibilities

Establish and maintain positive working relationships with contracted providers, staff and internal departments
Plans, implements and coordinates initial and ongoing provider education of professional/ancillary/hospital networks contracted for all BCBSAZ lines of business, including both the TriWest and Medicare lines of business
Facilitates the resolution of provider inquiries and issues
Responds timely to provider calls and emails. Works with internal departments to resolve provider issues.
Conduct and document provider visits. Provider visits must include reconciliation of provider rosters, review of any pertinent provider reporting including scorecards, quality reporting and other reports as identified. Provider visits may also include site visits of physician offices to comply with BCBSAZ requirements in conjunction with CMS.
The position requires the PRC to attend monthly onsite staff meetings and other meetings in person, as required.
Provide training and on-boarding to new team members (Lead)
Provide on-going team coach as needed (Lead)
Work with management to identify and implement efficiency opportunities (Lead)
Assists with oversight of assigned projects (Lead)
Provides team support with escalated inquires (Lead)
Maintains positive relationships with management (Lead)
Perform all other duties or special projects as assigned