Provider Relations Coordinator (AZ Remote)-1
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Purpose of the Job...
The Provider Relations Coordinator (PRC) is the primary BCBSAZ point of contact for contracted providers and responsible for effectively and efficiently resolving all provider issues.
Qualifications
REQUIRED QUALIFICATIONS
Required Work Experience
1 year of experience in Healthcare field (Applies to All Levels)
Required Education
High-School Diploma or GED in field of study (Applies to All Levels)
Required Licenses
Valid Arizona Driver License, with an acceptable driving record (Applies to All Levels)
Required Certifications
N/A
PREFERRED QUALIFICATIONS
Preferred Work Experience
2 years of experience in healthcare field, working with providers (Applies to All Levels)
Preferred Education
Associate's Degree in field of study (Applies to All Levels)
Preferred Licenses
N/A
Preferred Certifications
N/A
Essentials Job Functions and Responsibilities
Establish and maintain positive working relationships with contracted providers, staff and internal departments
Plans, implements and coordinates initial and ongoing provider education of professional/ancillary/hospital networks contracted for all BCBSAZ lines of business
Facilitates the resolution of provider inquiries and issues
Responds timely to provider calls and emails. Works with internal departments to resolve provider issues.
Conduct and document provider visits. Provider visits must include reconciliation of provider rosters, review of any pertinent provider reporting including scorecards, quality reporting and other reports as identified. Provider visits may also include site visits of physician offices to comply with BCBSAZ requirements in conjunction with CMS.
PRC provider visits must meet the following thresholds for provider visit based on type:
PCP no quality - at least semi-annual visits
PCP with quality - at least quarterly
Specialty no quality - at least annually
Specialty with quality - at least semi-annually
Ancillary with physical site- at least annually
Ancillary with no physician site (DME) - telephonic at least annually
Hospital system/Facility - monthly
Medicaid, according to contract, policy, or procedure requirements
The position requires the PRC to attend monthly onsite staff meetings and other meetings in person, as required.
ALL LEVELS
Each progressive level includes the ability to perform the essential functions of any lower levels.
The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
Perform all other duties or special projects as assigned.
Competencies
REQUIRED COMPETENCIES
Required Job Skills
Intermediate PC proficiency (Applies to All Levels)
Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (Applies to All Levels)
Intermediate skill in word processing, spreadsheet and database software (Applies to All Levels)
Required Professional Competencies
Ability to present and interact at a professional level (Applies to All Levels)
Ability to problem solve (Applies to All Levels)
Maintain confidentiality and privacy (Applies to All Levels)
Ability to prioritize and manage work assignments and work independently (Applies to All Levels)
Knowledge necessary to analyze reports based on available data and then make decisions based on reported data (Applies to All Levels)
Capable of investigative and analytical research (Applies to All Levels)
Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards (Applies to All Levels)
Establish and maintain working relationships in a collaborative team environment (Applies to All Levels)
Identify root causes and initiate solutions (Applies to All Levels)
Ability to manage multiple large provider groups/hospitals (Applies to Levels 2 - 3)
Ability to train entry level staff (Applies to Levels 2 - 3 )
Ability to communicate complex provider issues effectively (Applies to Levels 2 - 3 )
Demonstrates excellent relationships with providers (Applies to Levels 2 - 3)
Ability to manage high-level projects with minimal supervision (Applies to Level 3)
Ability to demonstrate diplomacy in all situations (Applies to Level 3)
Knowledge of claims and ability to perform claims research (Applies to Level 3)
Required Leadership Experience and Competencies
Exhibit strong leadership skills (Applies to Level 3)
Mentor and guide co-workers (Applies to Level 3)
PREFERRED COMPETENCIES
Preferred Job Skills
Advanced skill in word processing, spreadsheet and database software (Applies to All Levels)
Preferred Professional Competencies
Knowledge of provider reimbursement methodologies, contracts and networks (Applies to All Levels )
Knowledge of claims payment systems and ability to perform preliminary claims research (Applies to All Levels)
Preferred Leadership Experience and Competencies
Ability to positively influence others (Applies to Level 3)
Considered role model for co-workers (Applies to Level 3)
Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply
Apply Now
For more such jobs please click here!
Purpose of the Job...
The Provider Relations Coordinator (PRC) is the primary BCBSAZ point of contact for contracted providers and responsible for effectively and efficiently resolving all provider issues.
Qualifications
REQUIRED QUALIFICATIONS
Required Work Experience
1 year of experience in Healthcare field (Applies to All Levels)
Required Education
High-School Diploma or GED in field of study (Applies to All Levels)
Required Licenses
Valid Arizona Driver License, with an acceptable driving record (Applies to All Levels)
Required Certifications
N/A
PREFERRED QUALIFICATIONS
Preferred Work Experience
2 years of experience in healthcare field, working with providers (Applies to All Levels)
Preferred Education
Associate's Degree in field of study (Applies to All Levels)
Preferred Licenses
N/A
Preferred Certifications
N/A
Essentials Job Functions and Responsibilities
Establish and maintain positive working relationships with contracted providers, staff and internal departments
Plans, implements and coordinates initial and ongoing provider education of professional/ancillary/hospital networks contracted for all BCBSAZ lines of business
Facilitates the resolution of provider inquiries and issues
Responds timely to provider calls and emails. Works with internal departments to resolve provider issues.
Conduct and document provider visits. Provider visits must include reconciliation of provider rosters, review of any pertinent provider reporting including scorecards, quality reporting and other reports as identified. Provider visits may also include site visits of physician offices to comply with BCBSAZ requirements in conjunction with CMS.
PRC provider visits must meet the following thresholds for provider visit based on type:
PCP no quality - at least semi-annual visits
PCP with quality - at least quarterly
Specialty no quality - at least annually
Specialty with quality - at least semi-annually
Ancillary with physical site- at least annually
Ancillary with no physician site (DME) - telephonic at least annually
Hospital system/Facility - monthly
Medicaid, according to contract, policy, or procedure requirements
The position requires the PRC to attend monthly onsite staff meetings and other meetings in person, as required.
ALL LEVELS
Each progressive level includes the ability to perform the essential functions of any lower levels.
The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
Perform all other duties or special projects as assigned.
Competencies
REQUIRED COMPETENCIES
Required Job Skills
Intermediate PC proficiency (Applies to All Levels)
Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (Applies to All Levels)
Intermediate skill in word processing, spreadsheet and database software (Applies to All Levels)
Required Professional Competencies
Ability to present and interact at a professional level (Applies to All Levels)
Ability to problem solve (Applies to All Levels)
Maintain confidentiality and privacy (Applies to All Levels)
Ability to prioritize and manage work assignments and work independently (Applies to All Levels)
Knowledge necessary to analyze reports based on available data and then make decisions based on reported data (Applies to All Levels)
Capable of investigative and analytical research (Applies to All Levels)
Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards (Applies to All Levels)
Establish and maintain working relationships in a collaborative team environment (Applies to All Levels)
Identify root causes and initiate solutions (Applies to All Levels)
Ability to manage multiple large provider groups/hospitals (Applies to Levels 2 - 3)
Ability to train entry level staff (Applies to Levels 2 - 3 )
Ability to communicate complex provider issues effectively (Applies to Levels 2 - 3 )
Demonstrates excellent relationships with providers (Applies to Levels 2 - 3)
Ability to manage high-level projects with minimal supervision (Applies to Level 3)
Ability to demonstrate diplomacy in all situations (Applies to Level 3)
Knowledge of claims and ability to perform claims research (Applies to Level 3)
Required Leadership Experience and Competencies
Exhibit strong leadership skills (Applies to Level 3)
Mentor and guide co-workers (Applies to Level 3)
PREFERRED COMPETENCIES
Preferred Job Skills
Advanced skill in word processing, spreadsheet and database software (Applies to All Levels)
Preferred Professional Competencies
Knowledge of provider reimbursement methodologies, contracts and networks (Applies to All Levels )
Knowledge of claims payment systems and ability to perform preliminary claims research (Applies to All Levels)
Preferred Leadership Experience and Competencies
Ability to positively influence others (Applies to Level 3)
Considered role model for co-workers (Applies to Level 3)
Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply
Apply Now
For more such jobs please click here!