Director Provider Relations Jobs (NOW HIRING)

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with us.

Residency in or relocation to Louisiana is preferred for all positions.

POSITION PURPOSE

The Provider Relations Representative serves as the primary relationship manager between the Health Plan and contracted healthcare providers across an assigned territory. This role develops and maintains positive provider partnerships, improves provider satisfaction, supports network performance, and ensures providers have the knowledge, tools, and resources needed to effectively conduct business with the Plan.

The role proactively identifies provider concerns, investigates root causes, coordinates solutions across departments, and delivers provider education on health plan policies, procedures, products, reimbursement methodologies, electronic transaction capabilities, and strategic initiatives. Success is measured through provider satisfaction, issue resolution, provider engagement, adoption of health plan programs, operational improvements, and the strength of provider relationships.

How You Contribute to the Company's Mission In This Role

• Builds and maintains productive relationships with physicians, advanced practice providers, hospital and health system leaders, practice administrators, office managers, billing and revenue cycle staff, provider organizations, and ancillary providers and facilities.
• Serves as a trusted provider resource and advocate by resolving complex customer service-related issues, managing difficult conversations, and maintaining ownership through resolution and follow-up.
• Provides on-site education, electronic systems consultations, and individual and group training on Plan products, policies, procedures, billing guidelines, provider portals, e-Business tools, and operational requirements.
• Assesses provider educational needs and organizes provider workshops, webinars, statewide instructional seminars, and promotional activities to support provider satisfaction and engagement.
• Partners with internal departments, including Provider Relations Leadership, Network Development and Contracting, Network Operations, Provider Reimbursement, Claims Operations, EDI and eBusiness Solutions, Medical Management, Quality Improvement, Customer Service, Sales/Marketing, and Business Engineering teams to resolve issues and improve organizational performance.
• Prepares provider feedback reports, identifies utilization and service trends, recommends operational improvements, promotes e-Business capabilities, and escalates significant service failures to management for review and resolution.

Required Qualifications

• Bachelor's degree in Business, Healthcare, or a related field required.
• Four years of related experience may be substituted for the Bachelor's degree requirement.

• Minimum of two years of healthcare industry experience with a focus on provider relations, revenue cycle, managed care, or payor relations.

• Strong relationship management skills with the ability to build trust, credibility, and responsiveness with providers and healthcare leaders.
• Strong communication, collaboration, customer service, and provider advocacy skills.
• Ability to investigate issues, identify root causes, develop practical solutions, and coordinate cross-functional resolution efforts.
• Ability to influence provider behavior and operational outcomes without direct authority.
• Strong analytical skills with the ability to evaluate utilization trends and prepare reports and presentations for providers and leadership.
• Proficiency with Microsoft Office Suite, including Excel, PowerPoint, Outlook, and Word.
• Experience using Facets, CRM and provider management systems, provider data management platforms, provider portals, e-Business tools, and reporting systems.
• Excellent organizational, project management, critical thinking, and decision-making skills.
• Ability to manage multiple priorities and adapt in a rapidly changing healthcare environment.
• Professional presence when interacting with providers, executives, leadership teams, and internal partners.

Preferred Qualifications

• Four years of experience in provider relations, revenue cycle, managed care, or payor relations.
• Experience conducting provider education, workshops, webinars, or group training sessions.
• Experience supporting provider satisfaction, network performance, issue resolution, and operational improvement initiatives.
• Experience promoting electronic transaction capabilities and provider technology adoption.

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

• Ability to travel by car within your assigned territory.
• Perform other job-related duties as assigned within the scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately performed while sitting or standing.
• The ability to comprehend, document, calculate, visualize, and analyze information is required.

An Equal Opportunity Employer

All internal employees please apply through Workday Careers.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

We perform background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, we are a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.