Provider Relations Jobs (NOW HIRING)

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Job SummaryBASIC FUNCTION
HCSC is looking for a dynamic individual to join its Provider Relations team in HOUSTON TX! This position is responsible for providing support, as well as developing and maintaining cooperative working relationships with contracted providers. Will also be responsible for facilitating and enhancing provider ease of doing business with HCSC which includes issue tracking and resolution, educating, training, identifying trends and evaluating providers to ensure that all contractual and financial requirements are adhered to and performed. Incumbent also provides training and education to all Blue Cross contracted providers including, but not limited to: hospitals, physicians, free-standing surgery centers, free standing substance abuse facilities, free standing psych facilities, VA hospitals, and all other allied professional providers. This role is HYBRID/FLEX and requires in-office visibility three days per week, working from home the other two days.
NOTE: relocation is not available, sponsorship will not be extended either now or in the future.

JOB REQUIREMENTS/QUALIFICATIONS

• Bachelor's Degreeandthree (3)years of work experience in managed care OR aminimum offive (5) yearswork experience in a managed care environment.

• Two (2) years of healthcare administration experience in clinical and financial settings, with direct provider communication experience.

• Effective interpersonal, analytical,presentationand communication skills.

• Knowledge of the healthcare industry, healthcare systems and payer/provider dynamics.

• Ability and willingness to travel within assigned areas for responsibility, including overnight stays.

• Strong comprehension of contracts, applications, and products.

• Understanding ofprovider reimbursement methodologies and claims.

• Working knowledge of claims processing systems.

• Effective organizational and planning skills with the ability to take initiative and work independently.

• Demonstrated ability to meet deadlines and work well under pressure.

• Clear and concise interpersonal,verbaland written communication skills.

• Collaborationskills resulting in business/process improvements/changes.

• PC proficiency and skillsto includeWord, Excel, PowerPoint, etc.

• Strong facilitation,presentationand analytical skills.

PREFERRED REQUIREMENTS/QUALIFICATIONS

• Advanced level of Excel fluency (i.e. pivot tables, data validation, handling large data sets)
• Strong familiarity with claims, billing, and coding basics (CPT, ICD-10 helpful).
• CRM or provider management systems knowledge.

~ KEY FUNCTIONALITY ~

• Establishes andmaintainsrelationships between Blue Cross andcontractedproviders to promote and ensure that BCBS networks areperforming perthe contracted agreement(e.g.compliance,PEAQ,etc.).

• Act aspointof escalation for providersregardingaspects of theirrelationship with HCSC with possible topicsto includeoperations,claims,financial reimbursement, policies, procedures, and contractual issues.

• Maintains a thorough level of knowledge for all lines of businessto ensure provider contract compliance and performs investigative research upon the request of providersregardingthe intricate and detailed information for all lines of business.
• Maintains a thorough level of knowledgeregardingallProviderRelationssystems(e.g.: GUI, PPW,Salesforce, etc.)

• Assistsin conductinginternal and externalseminars and presentationsas needed for the improvement of HCSC / provider relationships.

• Lead internal and external meetings toassureand enhance provider success (e.g.: PowerPoint decks, Excel, analytics, presentation skills).

• Provides training and education to all Blue Cross contractedproviders including, but not limited to: hospitals, physicians, free-standing surgery centers, free standing substance abuse facilities, free standing psych facilities, VA hospitals, and all other allied professional providers.

• Represent Provider Relations in cross-department workflows and projects and ensureappropriate providerservices, including working across departments to resolve issues.

• Ensure assigned providers are informed when changes occur and respond to provider inquiries in an effective andtimelymanner and coordinate claims resolution to payment problems.

• Communicate and interact effectively and professionally with co-workers, management, customers, etc.

• Comply withHIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.

• Maintain complete confidentiality ofcompanybusiness.

• Ensure all expenditurescomply withcorporate and divisional expense guidelines.

• Maintain communication with managementregardingdevelopment within areas of assigned responsibilities and perform special projects asrequiredor requested.

• Maintainaccurateandtimelydocumentation within Salesforce, ensuring all provider interactions, outreach activities, issue resolution, and key relationship management details are consistently recorded and updated to support business operations, reporting, and performance tracking.

• Provide project support as needed, including tracking milestones, managing timelines, coordinating cross-functional activities, and contributing to project documentation and status updates.
• Responsible formaintainingan up-to-date tracker of provider concerns and pain points and participate in discussions around resolutions.

• Other duties as assigned by leadership.

#LI-TP1

#LI-HYBRID

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From 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, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment 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.

Base Pay Range$55,900.00 - $123,500.00

Exact compensation may vary based on skills, experience, and location.