Provider Relations Representative - Louisiana

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

11d • Onsite

About The Position

The Provider Relations Representative serves as the primary relationship manager between the Health Plan and contracted healthcare providers across an assigned territory. This role develops and maintains positive provider partnerships, improves provider satisfaction, supports network performance, and ensures providers have the knowledge, tools, and resources needed to effectively conduct business with the Plan. The role proactively identifies provider concerns, investigates root causes, coordinates solutions across departments, and delivers provider education on health plan policies, procedures, products, reimbursement methodologies, electronic transaction capabilities, and strategic initiatives. Success is measured through provider satisfaction, issue resolution, provider engagement, adoption of health plan programs, operational improvements, and the strength of provider relationships.

Requirements

• Bachelor's degree in Business, Healthcare, or a related field required. Four years of related experience may be substituted for the Bachelor's degree requirement.
• Minimum of two years of healthcare industry experience with a focus on provider relations, revenue cycle, managed care, or payor relations.
• Strong relationship management skills with the ability to build trust, credibility, and responsiveness with providers and healthcare leaders.
• Strong communication, collaboration, customer service, and provider advocacy skills.
• Ability to investigate issues, identify root causes, develop practical solutions, and coordinate cross-functional resolution efforts.
• Ability to influence provider behavior and operational outcomes without direct authority.
• Strong analytical skills with the ability to evaluate utilization trends and prepare reports and presentations for providers and leadership.
• Proficiency with Microsoft Office Suite, including Excel, PowerPoint, Outlook, and Word.
• Experience using Facets, CRM and provider management systems, provider data management platforms, provider portals, e-Business tools, and reporting systems.
• Excellent organizational, project management, critical thinking, and decision-making skills.
• Ability to manage multiple priorities and adapt in a rapidly changing healthcare environment.
• Professional presence when interacting with providers, executives, leadership teams, and internal partners.

Nice To Haves

• Four years of experience in provider relations, revenue cycle, managed care, or payor relations.
• Experience conducting provider education, workshops, webinars, or group training sessions.
• Experience supporting provider satisfaction, network performance, issue resolution, and operational improvement initiatives.
• Experience promoting electronic transaction capabilities and provider technology adoption.

Responsibilities

• Builds and maintains productive relationships with physicians, advanced practice providers, hospital and health system leaders, practice administrators, office managers, billing and revenue cycle staff, provider organizations, and ancillary providers and facilities.
• Serves as a trusted provider resource and advocate by resolving complex customer service-related issues, managing difficult conversations, and maintaining ownership through resolution and follow-up.
• Provides on-site education, electronic systems consultations, and individual and group training on Plan products, policies, procedures, billing guidelines, provider portals, e-Business tools, and operational requirements.
• Assesses provider educational needs and organizes provider workshops, webinars, statewide instructional seminars, and promotional activities to support provider satisfaction and engagement.
• Partners with internal departments, including Provider Relations Leadership, Network Development and Contracting, Network Operations, Provider Reimbursement, Claims Operations, EDI and eBusiness Solutions, Medical Management, Quality Improvement, Customer Service, Sales/Marketing, and Business Engineering teams to resolve issues and improve organizational performance.
• Prepares provider feedback reports, identifies utilization and service trends, recommends operational improvements, promotes e-Business capabilities, and escalates significant service failures to management for review and resolution.
• Ability to travel by car within your assigned territory.
• Perform other job-related duties as assigned within the scope of responsibilities.

Benefits

• Residency in or relocation to Louisiana is preferred for all positions.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level