Provider Relations Representative

HCSC•Springfield, IL

2d•Hybrid

About The Position

This position provides support to contracted providers and develops and maintains cooperative working relationships with them, facilitating and enhancing providers’ ease of doing business with HCSC. Responsibilities include tracking and resolving issues, providing education and training, identifying trends, and evaluating providers to ensure contractual and financial requirements are met. The representative supports medical insurance and claims-related inquiries, applies knowledge of Medicaid and Medicare business processes to resolve issues and educate providers, and addresses provider requests across a national scope while promoting consistent service and operational excellence. This is a Flex role requiring at least three days in the office and two days working from home. The position requires travel within assigned areas, including overnight stays. Sponsorship is not available. Compensation varies based on job-related skills, education, knowledge, experience, and location, and the role aligns with an annual incentive bonus plan subject to its terms and conditions.

Requirements

Bachelor’s degree and 3 years of work experience in managed care, or at least 5 years of work experience in a managed care environment.
At least 2 years of health care administration experience in clinical and financial settings, including direct provider communication.
Knowledge of Medicaid and Medicare business processes, including provider education and operational support.
Effective interpersonal, analytical, presentation, and communication skills.
Knowledge of the health care industry.
Ability and willingness to travel within assigned areas, including overnight stays.
Knowledge of contracts, applications, and products.
Understanding of 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.
Clear and concise verbal and written communication skills.
Collaboration skills that contribute to business or process improvements and changes.
PC skills and experience, including Word, Excel, and PowerPoint.
Sponsorship is not available.
Ability to work in the office at least three days a week and from home two days a week.

Nice To Haves

3 years of experience supporting medical insurance operations, claims handling, and provider issue resolution.
Experience researching, tracking, and resolving provider inquiries while maintaining a high level of service and responsiveness.
Proven ability to develop and maintain strong relationships with contracted providers and key stakeholders.
Experience identifying trends, resolving escalated issues, and recommending process improvements.
Knowledge of contractual and financial requirements related to provider network operations.
Experience supporting provider requests across multiple markets or a national provider network environment.
Strong communication and training skills, including the ability to educate providers on policies, processes, and business requirements.

Responsibilities

Develop and maintain cooperative working relationships with contracted providers.
Facilitate providers’ ease of doing business with HCSC.
Track and resolve provider issues and inquiries, including escalated issues.
Educate and train providers on policies, processes, business requirements, and Medicaid and Medicare operations.
Support providers with medical insurance and claims-related inquiries.
Evaluate providers and help ensure contractual and financial requirements are adhered to and performed.
Identify trends and recommend process improvements.
Address provider requests across a national scope while promoting consistent service and operational excellence.
Collaborate on business and process improvements or changes.