Government Programs Provider Representative

Under direction of the Manager of Institutional Provider Relations, has direct responsibility for institutional provider contracting, education and services of the Institutional Relations government programs (TriWest, Medicare Advantage and Healthy Blue). These providers include hospitals, home health, dialysis, ambulatory surgery centers and any other institutional providers added to any of the government program networks.

Supervises and conducts on-site provider financial and coding audits.

Assists in obtaining and negotiating contracts from providers as assigned by Manager of Institutional Relations.

This position is eligible to work hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

• Family Comes First: Total rewards package that promotes the idea of family first for all employees.

• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.

• Trust: Work for one of the most trusted companies in Kansas

• Stability: 80 years of commitment, compassion and community

• Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.

Compensation

$80,720 - 96,000

Exempt grade 16

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The salary range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive salaries that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

What you'll do

• Provides education, training and audit activities for government program institutional providers.

• Keeps providers informed in all programs administered by BCBSKS.

• Assists providers in all aspects of contract requirements and claims submission.

• Conducts educational seminars.

• Conducts case reviews of Members and other audits as required.

• Evaluates redetermination requests submitted by providers and, when appropriate, submits requests for reconsideration to management.

• Maintains an ongoing itinerary of provider visits.

• Participates in periodic team meetings to evaluate and analyze for resolution of provider issues, problems and challenges.

• Develops and maintains ongoing working relationship with administrators of institutional providers.

• This position requires approximately 45% travel and 45% overnight travel stays annually.

What you need

• Bachelors Degree in General Business, Accounting, Marketing or Hospital Administration/Health Economics strongly preferred. In lieu of the degree, a minimum of 5 years experience in a related field is required.

• Valid driver's license required.

Bonus if you have

• Comprehensive knowledge and understanding of procedural and diagnostic coding strongly preferred. Certification by the American Academy of Procedural Coders preferred.

• Basic background in hospital administration preferred.

• Knowledge of institutional provider claim billing procedures for TriWest and Medicare Advantage to include duties such as claim coding practices, ICD-10 diagnosis and procedure codes, revenue codes, HCPCS codes and/or CPT-4 codes preferred

• Knowledge of programs administered by Blue Cross and Blue Shield of Kansas (BCBSKS) preferred.

• Experience negotiating and analyzing contract language and identify possible discrepancies and recommend changes as appropriate.

Benefits & Perks

• Base compensation is only one component of your competitive Total Rewards package

• Incentive pay program (EPIP)

• Health/Vision/Dental insurance

• 6 weeks paid parental leave for new mothers and fathers

• Fertility/Adoption assistance

• 2 weeks paid caregiver leave

• 5% 401(k) plan matching

• Tuition reimbursement

• Health & fitness benefits, discounts and resources

Posting Close Date

June 23, 2024

Pay Rate Type

Salary