This job was posted by https://www.kansasworks.com : For more
information, please see: https://www.kansasworks.com/jobs/13227348
Under the supervision and direction of the Provider Relations Manager,
in collaboration with the Director of Provider Relations, the Provider
Relations Representative I is responsible for establishing
relationships for all Blue Cross and Blue Shield of Kansas (BCBSKS)
in-network providers and health systems, educating on new policies,
procedures and lines of business as well as discussing claim issues,
trends and reimbursement for all lines of business.
**This position may require travel up to 4-5 days per week, some
weekends, and overnight as applicable.
What youll 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 LOBs.
- 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.
What you need
- Bachelors 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.
- Valid driver\'s license.
- 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.
- 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 Medicare Advantage to include claim coding practices,
ICD-10 diagnosis and procedure codes, revenue codes, HCPCS codes and
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.
Bonus if you have
- General knowledge of all Blue Cross and Blue Shield lines of
business strongly preferred.
- Comprehensive knowledge and understanding of procedural and
diagnostic coding strongly preferred.
- Certification by the American Academy of Procedural oders
preferred.
- Basic background and knowledge in facility and professional provider
contracting preferred.
