Provider Relations Consultant

Summary
 As a Provider Relations Consultant, you will establish and maintain positive relationships with network hospitals, physician and / or dental practices, and their representatives. You will serve as point of contact for provider problems and issues. You will respond to non-routine or difficult problems and issues related to network contracts, reimbursement methodologies, benefit structure, medical policies, administrative policies, etc. You will also determine underlying cause(s) of problems and recommends changes to alleviate problems and issues. Coordinates/conducts meeting for problem resolution. Provides management with feedback on problems/issues.
Description
 

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Logistics: This position is onsite at 4101 Percival Rd. Columbia, SC, 29229. The hours are 8:00 a.m. – 5:00 p.m. Monday – Friday.

What You’ll Do:

• Serves as point of contact for provider problems/issues. Responds to non-routine or difficult problems/issues related to network contracts, reimbursement methodologies, benefit structure, medical policies, administrative policies, etc. Determines underlying cause(s) of problems and recommends changes to alleviate problems/issues. Coordinates/conducts meeting for problem resolution. Provides management with feedback on problems/issues.

• Creates educational materials (webinars, brochures, etc.) for providers. Educates providers on all lines of business such as Medicare Advantage, BlueChoice, FEP, State, as well as our corporate products, including the Exchanges. Explains coverage, website navigation, utilization statistics, and documentation requirements by use of written advisories, reports, letters, bulletins, telephone contacts and in person visits. Documents all provider contacts and communications in the provider education database.

• Conducts training in the following areas: electronic filing, reducing duplicate claims filings/incorrect claims filing, contract requirements, and reimbursements.

• Conducts workshops and speaks at conferences/meetings/conventions, etc. as requested by hospitals/physician and/or dental practice groups.

• Prepares/submits various reports to management.

• Work may involve some travel between office buildings.

• Some frequent / out-of-town travel may be required. You must have reliable transportation to perform duties.

To Qualify for This Position, You’ll Need:

• Required Education: Bachelor's

• Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience

• Required Work Experience: 5 years of healthcare, medical affairs, provider network, claims management, or combination of these. (2 of the 5 years must have been with direct health plan/payer programs)

• Required Software and tools: Microsoft Office.

Required Skills and Abilities:

• Knowledge/understanding of automated medical management systems and claims processing systems.

• Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills.

•  Demonstrated customer service, organizational, and presentation skills. Ability to persuade, negotiate, or influence others.

• Analytical or critical thinking skills.

•  Basic business math and knowledge of mathematical/statistical concepts.

•  Ability to handle confidential or sensitive information with discretion. Ability to lead and motivate employees.

What We Prefer:

• Public speaking skills.

• Claims experience.

• Prior experience training providers.

What We can Do for You:

• 401(k) retirement savings plan with company match.

• Subsidized health plans and free vision coverage.

• Life insurance.

• Paid annual leave – the longer you work here, the more you earn.

• Nine paid holidays.

• On-site cafeterias and fitness centers in major locations.

• Wellness programs and healthy lifestyle premium discount.

• Tuition assistance.

• Service recognition.

• Incentive Plan.

• Merit Plan.

• Continuing education funds for additional certifications and certification renewal.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications.  This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.