Provider Network Consultant

About the role

This position is responsible for developing and maintaining cooperative working relationships with the contracting provider community; educating, training, researching problems; and identifying trends and evaluating providers to ensure contractual and financial requirements are adhered to and performed. Ability and willingness to travel, including overnight stays.

Responsibilities

• Develop and maintain cooperative working relationships with the contracting provider community
• Educate, train, research problems, and identify trends and evaluate providers
• Ensure contractual and financial requirements are adhered to and performed

Requirements

• Bachelor’s degree in health care or business administration or a minimum of 4 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 and BCBSIL private business
• Ability and willingness to travel within assigned areas for responsibility, including overnight stays
• Extensive knowledge of contracts, applications, and products
• Demonstrated proficiency in provider reimbursement methods
• Working knowledge of claims processing systems
• Effective organizational and planning skills
• Ability to take initiative and work independently
• Demonstrated ability to meet deadlines and work well under pressure
• Working knowledge of software, including Microsoft Office

Qualifications

• Provider facing experience
• Claims processing experience is a plus
• Familiar with Government contracts i.e. regulatory/compliance
• Knowledge of Commercial line of business
• Project management experience
• Self starter

Skills

• Strong interpersonal and communication skills
• Excellent problem-solving and analytical skills
• Proficiency in Microsoft Office suite
• Knowledge of healthcare industry and BCBSIL private business
• Experience with claims processing systems
• Ability to manage multiple tasks and projects simultaneously

Benefits

Details on benefits are available upon request.

Pay

$55,900.00 - $123,500.00

Schedule

Hybrid schedule is offered.

Contact

To learn more about available benefits, please click here.

Equal Opportunity Employer

We are an Equal Opportunity Employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Get Jobs Alerts

Sign up and we’ll keep you up to date on the latest job opportunities that match your preferences.