Provider Representative

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust

Lansing, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.

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Competitive Total Compensation Package

Overview: Educates providers, office staff and billing entities about current BCN/BCBSM programs, policies and procedures. Analyze financial and utilization data to develop plans to assist providers in better managing patient care. Resolves problems with providers and staff including claims, eligibility, financial, utilization, performance improvement, disease management programs and other operational issues. Assist with the contracting of ancillary, primary and specialty providers, hospitals and PCG's.
Responsibilities: <ul> <li>Education of provider community regarding new providers and/or new office staff orientation, new products and programs, changes in existing policies, procedures and guidelines, managed care concepts, opportunities for improvement and performance; both quality and financial as well as credentialing and contracting.</li> <li>Servicing of provider community including analysis/resolution of complex claims issues, eligibility and capitation issues and other operational provider impacts.</li> <li>Liaison to billing entities regarding appropriate BCN billing procedures and other issues that may relate to their interactions with BCN.</li> <li>Primary liaison between the plan and the provider community regarding quality, utilization, credentialing, member services, provider inquiry, contract, financial and membership issues to ensure quality servicing standards.</li> <li>Performs financial and utilization analysis to identify performance problems with assigned primary care groups and providers.</li> <li>Assist with planning and serves as the lead in implementing performance improvement plans for assigned primary care groups and individual providers.</li> <li>Assists with implementation of provider contracting strategies and negotiations.</li> <li>Other duties as assigned.</li> </ul>
Requirements: <ul> <li>Bachelor's Degree in business or health related field required.</li> <li>Three (3) years of related experience in provider servicing, customer servicing, marketing or healthcare sales required.</li> <li>Intermediate knowledge of Microsoft Word, Excel and PowerPoint required.</li> <li>Excellent customer service and interpersonal skills including the ability to interact with internal and external customers and all levels of the organization required.</li> <li>Excellent written and verbal communication skills including the ability to conduct presentations required.</li> <li>Excellent organizational skills with the ability to handle multiple project and timelines required.</li> <li>Knowledge of HMO/Managed Care preferred.</li> <li>Knowledge of provider reimbursement principles preferred.</li> <li>Demonstrated ability to read, analyze and interpret a variety of reports, including utilization, quality and financial data.</li> <li>Demonstrated ability to write reports and business correspondence.</li> <li>Excellent public speaking skills required.</li> <li>Must be prepared to travel on a regular basis. Must have a valid drivers license, and provide own transportation.</li> <li>Early morning and late evening meetings are frequent.</li> </ul> <strong>DEPARTMENT PREFERENCE:</strong><br /> <ul> <li>Three (3) years provider training experience highly preferred.</li> </ul>