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Blue Cross and Blue Shield of Kansas · 12 hours ago

Provider Relations Representative

Wichita

Full-time

Onsite

Entry Level

3+ years exp

Blue Cross and Blue Shield of Kansas is a trusted healthcare provider in Kansas, seeking a Provider Relations Representative to establish relationships with in-network providers and health systems. The role involves educating providers on policies and procedures, resolving claim issues, and advocating for provider needs.

Financial ServicesHealth Care

Growth Opportunities

Responsibilities

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 LOB’s

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

Qualification

Provider contractingClaims submissionProcedural codingAnalytical skillsCommunication skillsHuman relations skillsComputer skillsBCBSKS programsCoverage guidelinesValue-Based Agreements

Required

Valid driver's license

High school diploma or equivalent is required

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/or Medicare Advantage to include claim coding practices, ICD-10 diagnosis and procedure codes, revenue codes, HCPCS codes and/or 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

Must support and exhibit the BCBSKS' value of integrity, dependability, service, growth and progress, and courage

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