Provider Network Consultant
Job Description:
• 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
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• 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
Apply tot his job
Apply To this Job