Provider Relations Representative - Louisiana

Blue Cross and Blue Shield of Louisiana•Baton Rouge, LA

13d•Onsite

About The Position

Extensive contact with all provider types to educate providers on Plan networks, policies and procedures, product lines, system capabilities, managed care requirements, billing guidelines, and reimbursement programs. Acts as a liaison between provider community and plan representatives to address complex claims. Promotes e-Business capabilities and establishes contractual arrangements with the provider community to decrease Plan administrative costs and expenses. Provides on-site electronic systems consultations and individual and group training to optimize system performance.

Requirements

Bachelor's degree in business, healthcare or a related field is required. Four years of related experience can be used in lieu of a Bachelor’s degree.
2 years of experience in the health care industry, focusing on customer service and establishing/maintaining business relationships with the provider community is required.
Knowledge of managed care and provider referral processes required.
Thorough knowledge and understanding of the Plan's e-Business capabilities, policies/procedures, product lines, claims processing, billing requirements, provider reimbursement systems and contractual agreements required.
Excellent organizational skills required.
Ability to prioritize multiple projects required.
Excellent public speaking, communication and interpersonal skills are required.
A high level of patience, empathy, and courtesy is required to deal with customers.
Excellent listening skills are required to effectively understand and address problems presented by the provider community.
Requires working knowledge of relevant PC software, mainframe capabilities and relevant office equipment.

Nice To Haves

Residency in or relocation to Louisiana is preferred for all positions.
Prefer 4 years of experience.

Responsibilities

Provides on-site education to Providers regarding the policies and procedures of conducting business with BCBSLA; resolves complex customer service related issues; and promotes provider satisfaction as outlined in the Provider Services Departmental Program.
Demonstrated basic understanding of all contractual provisions in Plan provider agreements.
Recommends changes to Plan’s systems, policies and procedures to improve provider satisfaction.
Promotes e-Business capabilities and establishes contractual arrangements with providers.
Provides on-site electronic systems consultations and individual and group training to optimize system performance.
Assesses providers' educational needs and conducts educational presentations to address those needs.
Organizes and conducts statewide instructional and promotional seminars/workshops to ensure provider satisfaction.
Prepares and submits weekly reports detailing feedback from providers regarding Plan's service, e-Business capabilities, recommendations to management for enhancing provider service capabilities, and specific educational needs related to Blue Cross Blue Shield products, policies and procedures.
Reports significant service failure issues of a presidential nature to management for review and resolution.
Perform other job-related duties as assigned, within your scope of responsibilities.