Provider Network Consultant

🌍 Remote, USA 🎯 Full-time 🕐 Posted Recently

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.

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