Provider Relations Representative

BJC Healthcare St. Louis , MO 63144

Posted 3 months ago

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BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and mid-Missouri regions. BJC serves patients and their families in urban, suburban and rural communities through its 15 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.
Includes Provider Relations staff who develop and maintain processes for improvement for the communications between the health plans and BJC entities and resolution of issues in a timely manner. Managed Care contracting resolves plan issues through contract language, and conducts an on-going process for monitoring BJC entity communications regarding managed care contracts and the impact on BJC entities. Represents BJC hospitals to managed care companies for contracting and provider relations. Works with Managed Care Finance to evaluate the financial impact of rate proposals, assuring the financial advantage of each contract. Provides plan administration for second level appeals and serve as the primary technical liaison with the TPA that administers BJC's self-insured health plan.
Join Us!
Role Purpose
Understands provider relationships and assists in activities that ensure the success of BJC providers in contract participation.
Provides operational support to the department leadership.
Assists with financial research and analysis for BJC providers and care plans.
Coordinates and recommends communication between participating parties in regard to contracts and financial issues.
Coordinates internal and external education, meetings and seminars.
Conducts audits of provider compliance with contractual obligations.
Minimum Requirements

High School Diploma or GED

2-5 years

Supervisor Experience
No Experience

Preferred Requirements and Additional Job Information

Associate's Degree

  • Business

5-10 years

Benefits Statement

Note: not all benefits apply to all openings

  • Comprehensive medical, dental, life insurance, and disability plan options

  • Pension Plan*/403(b) Plan

  • 401(k) plan

  • Tuition Assistance

  • Health Care and Dependent Care Reimbursement Accounts

  • On-Site Fitness Center (depending on location)

  • Paid Time Off Program for vacation, holiday and sick time
    *Pension does not apply to Memorial Hospital, Memorial Hospital East, Memorial Medical Group, Alton Memorial or Parkland Health Center

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Provider Relations Representative

BJC Healthcare