Provider Relations Representative

Blue Cross Blue Shield of Kansas • Topeka, KS • 3w ago

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13227348

Under the supervision and direction of the Provider Relations Manager, in collaboration with the Director of Provider Relations, the Provider Relations Representative I is responsible for establishing relationships for all Blue Cross and Blue Shield of Kansas (BCBSKS) in-network providers and health systems, educating on new policies, procedures and lines of business as well as discussing claim issues, trends and reimbursement for all lines of business.

**This position may require travel up to 4-5 days per week, some weekends, and overnight as applicable.

What youll do

Develops and maintains ongoing working relationships with providers.

Schedules regular cadence of in-person and virtual provider visits.

Serves as a provider advocate and liaison between the providers and

BCBSKS. This involves collaborating with internal staff to resolve problems to the satisfaction of both the providers and BCBSKS.

Keeps providers informed in all programs administered by BCBSKS.

Evaluates redetermination requests submitted by providers and, when

appropriate, submits requests for reconsideration to management.

Conducts provider workshops, webinars and teleconferences to educate

providers and/or their office staff.

Conducts case reviews of Members and other audits as requested and

required.

Assists providers in all aspects of contract requirements and claims

submission.

Responsible for provider contracting, reimbursement, and potential

negotiations for all BCBSKS LOBs.

Contributes to educational material and manuals developed for

facility and professional providers.

Coordinates implementation of new programs and procedures with

providers.

Regularly attends and represents BCBSKS in external community events

and programs.

What you need

Bachelors degree in general business, Accounting, Marketing or

Hospital Administration/Health Economics strongly preferred. In lieu of the degree, a minimum of 3 years experience in a related field is required.

Valid driver\'s license.

This position may require travel up to 4-5 days per week, some

weekends, and overnight as applicable.

Responsible for the delivery of provider materials and or conference

materials. This requires the ability to lift up to 50 pounds.

General ability to analyze contract language, identify possible

discrepancies and recommend changes as appropriate.

Basic human relations skills and oral and written communication

skills.

Strong computer skills to operate effectively with company systems

and programs.

General ability to analyze pertinent health system/provider

financial and reimbursement information for in depth analysis.

Basic working knowledge of claim billing procedures for Blue Cross,

TriWest and Medicare Advantage to include claim coding practices, ICD-10 diagnosis and procedure codes, revenue codes, HCPCS codes and CPT-4 codes.

Basic knowledge of coverage guidelines to include local medical

review policy criteria.

General ability to understand medical practices of all providers to

include knowledge of newly developed procedures and technology.

Basic knowledge of programs administered by BCBSKS.

Basic knowledge of industry standard Value-Based Agreements.

Must be accessible via text voice and or email and be available to

respond timely during non-working hours as scheduled if needed.

Bonus if you have

General knowledge of all Blue Cross and Blue Shield lines of

business strongly preferred.

Comprehensive knowledge and understanding of procedural and

diagnostic coding strongly preferred.

Certification by the American Academy of Procedural Coders

preferred.

Basic background and knowledge in facility and professional provider

contracting preferred.

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