Provider Network Consultant
Health Care Service Corporation
full-time
Posted on:
Location Type: Remote
Location: Illinois • Montana • United States
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Salary
💰 $55,900 - $123,500 per year
About the role
- Identifying, researching, resolving, and informing the Provider Performance staff and other divisions, and the external provider community about HealthSpring policy issues, system and contractual changes.
- Reviews current procedures to verify if still applicable to new programs, policies, and contracts.
- Responsible for educating, researching problems, and identifying trends to ensure that all contractual and financial requirements are adhered to and performed.
- Establishes and maintains relationships between HealthSpring and its providers to promote and ensure that issues are identified and resolved in a timely manner.
- Performs physician onboarding responsibilities for the HealthSpring networks.
- Collaborate daily with Provider Performance team to promote awareness and focus on high priority, or escalated, operational issues.
- Provides consultation to providers regarding independent decisions for all aspects of their operations, including financial reimbursement, policies, procedures, and contractual issues.
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
Benefits
- health and wellness benefits
- 401(k) savings plan
- pension plan
- paid time off
- paid parental leave
- disability insurance
- supplemental life insurance
- employee assistance program
- paid holidays
- tuition reimbursement
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
health care administrationprovider reimbursement methodsclaims processing systemscontract managementfinancial analysispolicy analysisproblem resolutiontrend identificationphysician onboarding
Soft Skills
interpersonal skillsanalytical skillspresentation skillscommunication skillsorganizational skillsplanning skillsinitiativeindependencedeadline managementability to work under pressure