Provider Relations Representative

HCSC•Springfield, IL

1d•Hybrid

About The Position

This position is responsible for the contracting, credentialing, and maintenance of professional provider data to support marketing, membership and network contracting across all lines of business; building relations with the provider community is an important part of this role. Responsibilities include promoting high-quality initiatives to support data integrity; accepting ownership and leading highly specialized operational and customer support duties that require independent initiative. This role includes participating in internal provider meetings and work groups, researching problems related to provider credentialing, data and network participation. Incumbent also provides training and education to all Blue Cross contracted providers including, but not limited to hospitals, physicians, free-standing surgery centers, free standing substance abuse facilities, free standing psych facilities, VA hospitals, and all other allied professional providers. NOTE: This role is HYBRID/FLEX and requires in-office visibility three days per week, working from home the other two days. Relocation is not available; sponsorship will not be extended either now or in the future.

Requirements

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.
Knowledge of the health care industry.
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.
Facilitation, presentation and analytical skills.

Nice To Haves

Experience analyzing provider performance, utilization, or operational metrics and translating findings into actionable recommendations for providers and internal stakeholders.
Experience supporting provider network initiatives, including provider onboarding, network expansion, value-based programs, or provider engagement strategies.
Demonstrated success managing complex, multi-department issue resolution efforts requiring coordination across operations, claims, network management, and other business areas.
Experience working with provider-facing reporting tools, dashboards, and data analysis to identify trends, monitor performance, and support decision-making.
Knowledge of physician practice operations, revenue cycle management, or healthcare office workflows, including an understanding of operational challenges impacting provider performance and satisfaction.
Advanced level of Excel fluency (i.e. pivot tables, data validation, handling large data sets).
Strong familiarity with claims, billing, and coding basics (CPT, ICD-10 helpful).
CRM or provider management systems knowledge.
Affiliation with IAMHP (Illinois Association of Medicaid Health Plans).
Experience working with government agencies, legislative and advocacy groups.

Responsibilities

Contracting, credentialing, and maintenance of professional provider data.
Support marketing, membership, and network contracting across all lines of business.
Build relations with the provider community.
Promote high-quality initiatives to support data integrity.
Accept ownership and lead highly specialized operational and customer support duties requiring independent initiative.
Participate in internal provider meetings and work groups.
Research problems related to provider credentialing, data, and network participation.
Provide training and education to all Blue Cross contracted providers (hospitals, physicians, surgery centers, substance abuse facilities, psych facilities, VA hospitals, and allied professional providers).