BlueCross BlueShield of South Carolina · 19 hours ago
Provider Relations Consultant (Healthy Blue Medicaid)
Columbia, SC
Full-time
Hybrid
Senior Level
5+ years expBlueCross BlueShield of South Carolina is one of the largest insurance companies in South Carolina and a leading administrator of government contracts. The Provider Relations Consultant will establish and maintain positive relationships with network providers, serve as a point of contact for provider issues, and create educational materials for providers while conducting various training sessions.
Financial ServicesHealth CareHealth InsuranceInsuranceMedical
Responsibilities
Serves as point of contact for provider problems/issues. Responds to non-routine or difficult problems/issues related to network contracts, reimbursement methodologies, benefit structure, medical policies, administrative policies, etc. Determines underlying cause(s) of problems and recommends changes to alleviate problems/issues. Coordinates/conducts meeting for problem resolution. Provides management with feedback on problems/issues
Creates educational materials (webinars, brochures, etc.) for providers. Educates providers on all lines of business such as Medicare Advantage, BlueChoice, FEP, State, as well as our corporate products, including the Exchanges. Explains coverage, website navigation, utilization statistics, and documentation requirements by use of written advisories, reports, letters, bulletins, telephone contacts and in person visits. Documents all provider contacts and communications in the provider education database
Conducts training in the following areas: electronic filing, reducing duplicate claims filings/incorrect claims filing, contract requirements, and reimbursements
Conducts workshops and speaks at conferences/meetings/conventions, etc. as requested by hospitals/physician and/or dental practice groups
Prepares/submits various reports to management
Qualification
Required
Bachelor's degree
Four (4) years job related work experience or Associate's and Two (2) years job related work experience
Five (5) years of healthcare, medical affairs, provider network, claims management, or combination of these. Two (2) of the Five (5) years must have been with direct health plan/payer programs
Knowledge/understanding of automated medical management systems and claims processing systems
Ability to work independently, prioritize effectively, and make sound decisions
Good judgment skills
Demonstrated customer service, organizational, and presentation skills
Ability to persuade, negotiate, or influence others
Analytical or critical thinking skills
Basic business math and knowledge of mathematical/statistical concepts
Ability to handle confidential or sensitive information with discretion
Ability to lead and motivate employees
Microsoft Office
Typical office environment. May involve some travel between office buildings and some/frequent out of town travel
Preferred
Bachelor's degree-in Business Administration, Business Management, Healthcare Administration, Marketing, or other job related field
3 years of previous supervisory or management experience
Knowledge of marketing and contracting
Working knowledge of Microsoft Access or other database software
Active Nursing/RN licensure in state hired or active LPN licensure in state hired
Company
BlueCross BlueShield of South Carolina
For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
April Richardson
Vice President and Chief Operating Officer of Companion Benefit Alternative
Alli McGary
Talent Acquisition Partner
Recent News
2025-09-13
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