- Interact with management and officers within provider organizations to provide information and interpretation of HCSC provider contracts, billing requirements, and claims payment procedures.
- Identify and coordinate resolution of reoccurring claims payment issues and policies between provider, FSUs and Hospital/Ancillary Contract Representative.
- Actively participate in provider operation meetings to identify, develop, and monitor potential areas of operational improvement that will strengthen the ongoing relationship with the provider.
- Maintain knowledge of HCSC claims processing systems including system capabilities and facility reimbursement methodologies.
- Provide orientation, training and policy education to provider office staff, billing staff and referral/precertification areas. Ensure providers are informed when changes occur in network state plan or HCSC policies and procedures and provide appropriate education/in-service.
- Respond to provider inquiries in a timely manner and help in claims resolution and payment problems. Work closely with Health Care Finance, FSUs, Utilization Management, Medical, Core Credentialing, Provider Automation and other divisions within the company.
- Establish and maintain relationships with providers through personal visits, correspondence and telephone calls.
- Participate in workgroups to develop new or modify current claims requirements, policies, and guidelines.
- Maintain and enhance working knowledge of the various HCSC billing and payment systems.
- Provide assistance to contracting representatives to ensure contract provisions can be systematically supported.
- Review claims or other provider issues and ensure contracts are loaded properly in Blue Cross systems.
- Ensure all expenditures comply with corporate and divisional expense guidelines.
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provider relations representative - Albuquerque, NM , USA, United States - HCSC
Description
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success.We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your futureJob Summary
This position is responsible for enhancing relationships with facility and physician providers; and acting as liaison with providers through education, training, claims assistance and ongoing provider service.
Job Responsibilities:
Required Job Qualifications:
*Bachelor Degree and 1 year managed care experience in products or contracts OR 5 years' experience in managed care environment with 1 year experience in products or contracts. *1 year experience in a position that demonstrates leadership abilities and sound decision-making. *Knowledge of contracts, applications and products; claims processing systems. *Knowledge and experience in provider reimbursement methods. *Meet deadlines and work well under pressure and take initiative to work independently. *Verbal and written communication skills; organizational and planning skills. *PC proficiency to include Microsoft Office. *Ability and willingness to travel, including overnight stays.
Preferred Job Qualifications:
*1 year experience in provider relations.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace.
Drug screening and background investigation are required, as allowed by law.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
provider relations representative professionals in Albuquerque
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Carey Salaz
Regulatory/Compliance & Project Management Leader
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John Lake
IT Professional