Maintains relationships with providers by daily interaction and delivers technical assistance to correct any errors and control risks for the insurer and provider.Job Description:Job Responsibilities
Identifying educational topics, methods, and strategies to enhance compliance throughout the provider network.
Implementing, supporting, and monitoring provider programs and enterprise initiatives
Implementing processes and changes needed to maintain regulatory compliance, contract compliance or to improve quality.
Handling escalated provider enrollment processing and problem resolution.
Leading data reporting and analysis projects to monitor financial and service relations with providers.
Consulting with providers on delivery, training and support related issues, identifying opportunities for enhancement and recommending solutions.
Able to travel to provider offices or conduct virtual meetings as required.
Job QualificationsEducation
Bachelors degree in business or healthcare or relevant field or equivalent work experience required
Experience
3 years - Experience in provider relations and network development with emphasis on healthcare education and reimbursement.
SkillsCertifications
Ability to speak in public and conduct effective presentations.
Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
Demonstrated ability to interpret and translate technical and/or or complex concepts into information meaningful to project team members and/or business personnel.
Proficient in Microsoft Office (Outlook, Word, Excel, Access and PowerPoint)
Accuracy and attention to detail
Effective time management skills
Excellent oral and written communication skills
Strong interpersonal and organizational skills
Strong analytical skills
Ability to manage multiple projects and priorities
Positive attitude, self-driven, engaging, proactive, results drive
Knowledge in Medical terminology
Knowledge of contract language and reimbursement methodologies, managed care business processes, case-mix adjustment, medical terminology, utilization management and applications for claims payment, required.
License
Valid Driver's License
Job Specific Requirements:needs to be in the Johnson City/Knoxville area preferred facets 6 months preferred care advance 6 monthsPreferred Skills:Number of Openings Available:1Worker Type:EmployeeCompany:VSHP Volunteer State Health Plan, IncRemote-First Statement:BCBST is a remote-first organization with many employees working primarily from their homes. Each position within the company is classified as either fully remote, partially remote, or office based.BCBST hires employees for remote positions from across the U.S. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense. If the applicant moves to Chattanooga, TN, they may be eligible for relocation benefits.Applying for this job indicates your acknowledgement and understanding of the following statements:BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:BCBST's EEO Policies/Notices (https://www.bcbst.com/docs/equal-employment-opportunity.pdf)BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.Tobacco-Free Hiring StatementTo further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotineand/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.
