Provider Relations Representative

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Family Comes First: Total rewards package that promotes the idea of family first for all employees.
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.

Compensation

$72,000 - $86,000

Exempt grade 15

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The salary range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid.  All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive salaries that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

What you’ll 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 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.

Knowledge/Skills/Abilities

• Basic background and knowledge in facility and professional provider contracting preferred.
• 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.

What you need

• Bachelor’s 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.
• Comprehensive knowledge and understanding of procedural and diagnostic coding strongly preferred.  Certification by the American Academy of Procedural Coders preferred.
• Valid driver's license.

Benefits & Perks

• Base compensation is only one component of your competitive Total Rewards package
  • Incentive pay program (EPIP)
  • Health/Vision/Dental insurance
  • 6 weeks paid parental leave for new mothers and fathers
  • Fertility/Adoption assistance
  • 2 weeks paid caregiver leave
  • 5% 401(k) plan matching
  • Tuition reimbursement
  • Health & fitness benefits, discounts and resources

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.