Provider Network Consultant I

Overview

Department Overview

Provider Engagement and Support develops pricing and reimbursement strategies, credentials, educates and supports our provider partners to establish shared accountability to include the delivery of appropriate, high quality, cost-effective care. Provider Engagement and Support serves as the liaison between the provider community and Blue Cross, by managing networks, building relationships, providing education, and identifying and resolving problems.

Primary Responsibilities

The Provider Network Consultant I serves as a consultant and corporate liaison to health care providers, external vendors, and other internal stakeholders in key areas of the Company. Health care providers served include physicians, hospital administrators, and all ancillary providers. The overall role is providing both contracting and consultative services to the provider community, developing and promoting corporate objectives, solutions and services, and supporting providers with all administrative aspects of healthcare delivery. The goal of providing consultative services is to guide providers in a way that positively impacts all aspects of their administrative and clinical efficiency/effectiveness to assist in providing the highest quality and most cost effective healthcare to Blue Cross and Blue Shield of Alabama members. The position must interact with all levels of the Company and also participate in corporate level projects and initiatives. The incumbent is expected to interact via phone, email, and in on-site or off-site face to face meetings with providers, vendors, medical community leadership, and other key areas of the Company independently with minimal management intervention. The incumbent must develop general knowledge of member and provider contract benefits, clinical guidelines, medical policy and claims processing for all lines business.

Summary of Qualifications

• Bachelor's Degree
• Two years of experience working in the healthcare industry
• Experience in a position interpreting and communicating information orally and written
• Experience in a position exercising independent judgment and decision making
• Experience in a position resolving difficult and stressful situations
• Experience in a position identifying and solving problems
• Experience working with various Microsoft Office programs
• Willingness to travel out of the office and overnight
• Experience managing multiple projects with various priorities
• Experience in a position using analytical skills preferred
• Experience or understanding of workflows and technologies within the physician practices and hospitals preferred
• Experience understanding and interpreting medical policy and member benefits preferred
• Experience in a position leading complex projects preferred
• Experience with statistical reporting (e.g. Crystal Reports, Tableau, Excel, etc.)preferred
• Experience leading and controlling effective meetings, both internally and externally preferred
• Experience in building relationships and networking to obtain the trust of business owners, Information Technology (IT), and stakeholders preferred
• Experience in a position preparing correspondence, contracts, documents etc. preferred
• Familiarity with medical terminology preferred
• Exposure to claims processing procedures preferred
• Experience in a position working independently under little or no supervision preferred
• Experience in a position organizing and prioritizing tasks preferred
• Experience with Accountable Care Organization (ACO) and Medical Loss Ration (MLR) preferred

Note: Position may be filled at a higher level based on experience.

Work Location

The work location for this position will be hybrid (onsite/remote).

Terms and Agreements

By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews.
We appreciate your interest in Blue Cross and Blue Shield of Alabama 'The Company'. The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or because of citizenship status in the case of a citizen or intending citizen. No question on this application is intended to secure information to be used for such discrimination.
Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association

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