Senior Provider Relations Representative - Remote

Health Care Service Corporation•National, NV

4d•$63,300 - $114,300•Remote

About The Position

This position is responsible for providing support, as well as developing and maintaining cooperative working relationships with providers while facilitating and enhancing provider ease of doing business with HCSC. This includes establishing and maintaining provider relationships to support network performance, serving as a resource and point of escalation for provider concerns, issue tracking and resolution, educating and training providers, identifying trends, and evaluating provider performance to ensure operational and financial requirements are met.

Requirements

Bachelor’s degree in business OR 6 years leadership experience.
4 years’ experience in claims, customer service, physician office or hospital or healthcare environment.
3 years’ experience in a position which requires in-depth physician/provider relations, including but not limited to, contracting and reimbursement issues.
Ability to negotiate and contract with healthcare providers.
Platform skills; organizational and planning skills; and ability to take initiative and work independently.
Ability to multi-task; meet deadlines and work well under pressure.
Ability and willingness to travel within assigned areas of responsibility, including overnight stays.
PC proficiency to include Microsoft Office

Nice To Haves

Bachelor’s degree and 3 years of work experience in managed care, or a minimum of 5 years’ work experience in a managed care environment.
Minimum of 2 years of health care administration experience in clinical and financial settings, with direct provider communication experience.
Effective interpersonal, analytical, presentation and communication skills.
Ability and willingness to travel within assigned areas for responsibility, 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.
Analytical skills.
Ability to take initiative and work independently.
Demonstrated ability to meet deadlines and work well under pressure.
Clear and concise interpersonal, verbal and written communication skills.
Collaboration skills resulting in business/process improvements/changes.
PC experience and skills to include Word, Excel, PowerPoint, etc.
Demonstrated success building and maintaining relationships with physician groups, hospitals, and provider leadership.
Experience conducting provider education, training, and face-to-face consultations.
Extensive Medicaid and Medicare Advantage experience.
Knowledge of healthcare contracting, reimbursement methodologies, and managed care operations.
Prior territory management experience.
Knowledge of BCBSTX claims processing systems.

Responsibilities

Establishing and maintaining provider relationships to support network performance
Serving as a resource and point of escalation for provider concerns
Issue tracking and resolution
Educating and training providers
Identifying trends
Evaluating provider performance to ensure operational and financial requirements are met
Negotiate and contract with healthcare providers