Senior Provider Relations Representative Jobs in Spring, TX

• Bachelor's degreewith 5yearshealthcare and/or managed care insurance experience OR 7yearshealthcare and/or managed care insurance experience.

• Experience managing a department project or aportionof a divisional or corporate project, including analysis, strategy forming, developing project management plans, developingappropriate resources, and implementation.

• Minimum of 3 years of health care administration experience in clinical and financial settings, with direct provider communication experience.

• Experience independentlymanaging to resolutioncomplex issues across multiple divisions.

• Experience leading/providing guidance to intra and interdepartmental staff.

• Knowledge of current health care products, the external marketplace, and HCSC competition.

• Experience communicatingwith andrelationship building with various internal and external customers and providers.

• Clear and concise interpersonal,verbaland written communication skills.

• Collaboration skills resulting in business/process improvements/changes.

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

• Facilitation,presentationand analytical skills.

Preferred Job Qualifications

• Bachelor's degree in Healthcare Administration or Business Management.

• Knowledge of HCSC's variousfunctionsareas and departments.

~ KEY FUNCTIONS ~

• Manages 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, 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.
• 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.
• 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.
• Establish and maintain relationships with assigned providers through personal visits, correspondence and telephone calls.
• Maintains a thorough level of knowledge for all lines of business to ensure provider contract compliance.
• Conduct internal and external seminars and presentations as needed for the improvement of HCSC / provider relationship.
• Maintains an expert level of knowledge regarding all Provider Relations systems (e.g.: GUI, PPW, Salesforce, etc.)
• 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.
• Build, contribute to, and present PowerPoint decks and analytics related to provider success. Presents to key account representatives on provider health and utilization patterns.
• Leads internal staff and participates in the investigation, resolution, and monitoring of identified problems.
• Works with internal departments (PASS, Legal, Contracting, PDM, etc.) to bring open issues to resolution.
• Oversees and analyze data to identify provider pain points and offer recommendations for improvement.
• Provides interface with external clients or providers/facilities regarding existing contractual agreements and assessing the integrity and completeness and any subsequent impacts.
• Collaborate with Contracting regarding existing and proposed contractual agreements and assessing 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 improvement of 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.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Ensure all expenditures comply with corporate and divisional expense guidelines.
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
• Responsible for maintaining an up-to-date tracker of provider concerns and pain points. Participate in discussions around resolutions.
• Maintain accurate and timely documentation 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.
• Other duties as assigned by leadership
• Provide project support as needed, including tracking milestones, managing timelines, coordinating cross-functional activities, and contributing to project documentation and status updates.
• Other duties as assigned by leadership

#LI-TP1

#LI-HYBRID