Consultant, Provider Relations

About the role

Establishes and maintains positive relationships with network hospitals, physician and/or dental practices, and their representatives. 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.

Why join BlueCross BlueShield of South Carolina? Other companies come and go, but we've been part of the national landscape for more than seven decades, 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, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Responsibilities

• 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 meetings 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 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 electronic filing, reducing duplicate claims filings/incorrect claims filing, contract requirements, and reimbursements.
• Conducts workshops and speaks at conferences/meetings/conventions as requested by hospitals/physician and/or dental practice groups.
• Prepares/submits various reports to management.

Qualifications

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.

Skills

• Microsoft Office (preferred)
• Preferred Education: Bachelor's degree in Business Administration, Business Management, Healthcare Administration, Marketing, or other job‑related field.
• Preferred Work Experience: 3 years of previous supervisory or management experience.
• Preferred Skills and Abilities: Knowledge of marketing and contracting.
• Preferred Software and Other Tools: Working knowledge of Microsoft Access or other database software.
• Preferred Licenses and Certificates: Active RN licensure in state hired or active LPN licensure in state hired.

Benefits

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off