Health Care Service Corporation

Empowering Whole Person Health With Compassion and Innovation

Provider Network Consultant

Network EngineerNetwork EngineerFull TimeRemoteTeam 10,001+H1B SponsorCompany SiteLinkedIn

Location

Illinois + 5 moreAll locations: Illinois, Montana, New Mexico, Oklahoma, Tennessee, Texas

Posted

4 days ago

Salary

$55.9K - $123.5K / year

Bachelor Degree2 yrs expEnglish

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.

Job 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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