Senior Provider Relations Representative

About the role

This position is responsible for developing and maintaining healthy relationships with providers. It involves a high level of expertise in hospital and/or professional provider operations, A/R management, and healthcare structure. The role acts as a knowledgeable resource for providers and internal partners, serving as a liaison between the department and all areas of HCSC. Leadership is required to drive for better reporting and quality of provider experience.

Responsibilities

• Manage critical relationships between Blue Cross and its providers to promote and ensure quality provider relationships and enforcement of negotiated terms.
• Function as a primary SME in the department.
• Play a leadership role to establish, maintain, and grow relationships with assigned providers.
• Ensure appropriate provider services including working across departments to resolve issues. Ensure assigned providers are informed when changes occur in policies and procedures and provide appropriate education/in-service. Coordinate orientation, training, and continuing policy education to provider office staff, billing staff, and referral/precertification areas.
• Accountable for tracking and resolving provider open issues in a timely and professional manner.
• Respond to provider inquiries in an effective and timely manner and help in claims resolution and payment problems. Must work closely with Health Care Finance, Member Services, Utilization Management, Medical, Delegation Oversight (practitioners only), Core Credentialing, Provider Automation and other divisions within the company.
• Maintain a thorough level of knowledge for all lines of business to ensure provider contract compliance.
• Build, contribute to, and present PowerPoint decks and analytics related to provider success. Presents to key account representatives on provider health and utilization patterns.
• Oversees and analyzes data to identify provider pain points and offer recommendations for improvement.
• Provides interface with external clients or providers/facilities regarding existing contractual agreements and assesses the integrity and completeness and any subsequent impacts.
• Collaborate with Contracting regarding existing and proposed contractual agreements and assesses the subsequent impacts.
• Shares feedback ahead of the rollout of provider impacting tools and functionality.
• Acts as a liaison with other departments in execution of necessary business projects (e.g. directories, website content, rosters, etc.).
• Prepare for and lead internal and external meetings to assure and enhance provider success (e.g. PowerPoint decks, Excel, analytics, presentation skills).
• Assists in improving provider experience through automation, process, or data change recommendations.
• Leads, controls, and monitors complex interdivisional projects and reports on these projects to leadership.
• Communicate and interact effectively and professionally with co-workers, management, customers, etc.

Requirements

• Bachelor’s degree with 5 years healthcare and/or managed care insurance experience OR 7 years healthcare and/or managed care insurance experience.
• Experience managing a department project or a portion of a divisional or corporate project, including analysis, strategy forming, developing project management plans, developing appropriate resources, and implementation.
• Minimum of 3 years of health care administration experience in clinical and financial settings, with direct provider communication experience.
• Experience independently managing to resolution complex issues across multiple divisions.
• Experience leading or providing guidance to intra and interdepartmental staff.
• Knowledge of current health care products, the external marketplace, and HCSC competition.
• Experience communicating with and relationship building with various internal and external customers and providers.
• 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.

Qualifications

• Bachelor’s degree in Healthcare Administration or Business Management.
• Knowledge of HCSC’s various functions areas and departments.

Skills

• Expertise in hospital and/or professional provider operations, A/R management, and healthcare structure.
• High level of expertise in managing department projects and providing guidance to staff.
• Strong communication and interpersonal skills.
• Ability to manage complex issues and collaborate with internal and external stakeholders.
• Proficiency in Microsoft Office Suite.
• Effective facilitation, presentation, and analytical skills.

Benefits

Details on benefits are available upon request.

Pay

$61,500.00 - $136,100.00

Schedule

The role is hybrid/flex, requiring in-office visibility three days per week and working from home the other two days.