Provider Relations Representative

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.

Residency in or relocation to Louisiana is preferred for all positions.

This position is mostly remote.

POSITION PURPOSE

Extensive contact with all provider types to educate providers on Plan networks, policies and procedures, product lines, system capabilities, managed care requirements, billing guidelines, and reimbursement programs. Acts as a liaison between provider community and plan representatives to address complex claims. Promotes e-Business capabilities and establishes contractual arrangements with the provider community to decrease Plan administrative costs and expenses. Provides on-site electronic systems consultations and individual and group training to optimize system performance.

NATURE AND SCOPE

• This role does not manage people

• This role reports to this job: MANAGER, PROVIDER RELATIONS

• Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with:

All levels of Plan management, EDI, Network Development, Network Operations, Provider Reimbursement, Marketing, Legal, and Benefits Administration; externally with Providers and office staff personnel.

QUALIFICATIONS

Education

• Bachelor's degree in business, healthcare or a related field is required.

• Four years of related experience can be used in lieu of a Bachelor's degree.

Work Experience

• 2 years of experience in the health care industry, focusing on customer service and establishing/maintaining business relationships with the provider community is required. Prefer 4 years of experience.

Skills and Abilities

• Knowledge of managed care and provider referral processes required.

• Thorough knowledge and understanding of the Plan's e-Business capabilities, policies/procedures, product lines, claims processing, billing requirements, provider reimbursement systems and contractual agreements required.

• Excellent organizational skills required.

• Ability to prioritize multiple projects required.

• Excellent public speaking, communication and interpersonal skills are required.

• A high level of patience, empathy, and courtesy is required to deal with customers.

• Excellent listening skills are required to effectively understand and address problems presented by the provider community.

• Requires working knowledge of relevant PC software, mainframe capabilities and relevant office equipment.

• This job requires travel throughout the state 60-75% of the time with primary responsibility for assigned territory.

Licenses and Certifications

• None Required

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Provides on-site education to Providers regarding the policies and procedures of conducting business with BCBSLA; resolves complex customer service related issues; and promotes provider satisfaction as outlined in the Provider Services Departmental Program. Demonstrated basic understanding of all contractual provisions in Plan provider agreements. Recommends changes to Plan's systems, policies and procedures to improve provider satisfaction.

• Promotes e-Business capabilities and establishes contractual arrangements with providers. Provides on-site electronic systems consultations and individual and group training to optimize system performance.

• Assesses providers' educational needs and conducts educational presentations to address those needs. Organizes and conducts statewide instructional and promotional seminars/workshops to ensure provider satisfaction.

• Prepares and submits weekly reports detailing feedback from providers regarding Plan's service, e-Business capabilities, recommendations to management for enhancing provider service capabilities, and specific educational needs related to Blue Cross Blue Shield products, policies and procedures. Reports significant service failure issues of a presidential nature to management for review and resolution.

• Frequent overnight travel required. Ability to travel in a car for more than 2 hours at a time.

Additional Accountabilities and Essential Functions

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.

• Job duties are performed in a normal and clean office environment with normal noise levels.

• Work is predominately done while standing or sitting.

• The ability to comprehend, document, calculate, visualize, and analyze are required.

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An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.