Provider Relations Coordinator

2 weeks ago

Phoenix, United States Blue Cross Blue Shield of Arizona Full time

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

Purpose of the Job

The Provider Relations Coordinator (PRC) is the primary BCBSAZ point of contact for contracted providers and responsible for effectively and efficiently resolving all provider issues.

**Qualifications**:
REQUIRED QUALIFICATIONS

Required Work Experience
- 1 year of experience in Healthcare field (Applies to All Levels)

Required Education
- High-School Diploma or GED in field of study (Applies to All Levels)

Required Licenses
- Valid Arizona Driver License, with an acceptable driving record (Applies to All Levels)

Required Certifications
- N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience
- 2 years of experience in healthcare field, working with providers (Applies to All Levels)

Preferred Education
- Associate's Degree in field of study (Applies to All Levels)

Preferred Licenses
- N/A

Preferred Certifications
- N/A

Essentials Job Functions and Responsibilities
- Establish and maintain positive working relationships with contracted providers, staff and internal departments
- Plans, implements and coordinates initial and ongoing provider education of professional/ancillary/hospital networks contracted for all BCBSAZ lines of business
- Facilitates the resolution of provider inquiries and issues
- Conduct and document provider visits. Provider visits must include reconciliation of provider rosters, review of any pertinent provider reporting including scorecards, quality reporting and other reports as identified. Provider visits may also include site visits of physician offices to comply with BCBSAZ requirements in conjunction with CMS.
- PRC provider visits must meet the following thresholds for provider visit based on type:

- PCP no quality - at least semi-annual visits
- PCP with quality - at least quarterly
- Specialty no quality - at least annually
- Specialty with quality - at least semi-annually
- Ancillary with physical site
- at least annually
- Ancillary with no physician site (DME) - telephonic at least annually
- Hospital system/Facility - monthly
- Medicaid, according to contract, policy, or procedure requirements
- The position requires the PRC to attend monthly onsite staff meetings and other meetings in person, as required.

ALL LEVELS
- Each progressive level includes the ability to perform the essential functions of any lower levels.
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Perform all other duties or special projects as assigned.

Competencies

REQUIRED COMPETENCIES

Required Job Skills
- Intermediate PC proficiency (Applies to All Levels)
- Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (Applies to All Levels)
- Intermediate skill in word processing, spreadsheet and database software (Applies to All Levels)

Required Professional Competencies
- Ability to present and interact at a professional level (Applies to All Levels)
- Ability to problem solve (Applies to All Levels)
- Maintain confidentiality and privacy (Applies to All Levels)
- Ability to prioritize and manage work assignments and work independently (Applies to All Levels)
- Knowledge necessary to analyze reports based on available data and then make decisions based on reported data (Applies to All Levels)
- Capable of investigative and analytical research (Applies to All Levels)
- Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards (Applies to All Levels)
- Establish and maintain working relationships in a collaborative team environment (Applies to All Levels)
- Identify root causes and initiate solutions (Applies to All Levels)
- Ability to manage multiple large provider groups/hospitals (Applies to Levels 2 - 3)
- Ability to train entry level staff (Applies to Levels 2 - 3 )
- Ability to communicate complex provider issues effectively (Applies to Levels 2 - 3 )
- Demonstrates excellent relationships with providers (Applies to Levels 2 - 3)
- Ability to manage high-level projects with mínimal supervision (Applies to Level 3)
- Ability to demonstrate diplomacy in all situations (Applies to Level 3)
- Knowledge of claims and ability to perform claims research (Applies to Level 3)

Required Leadership Experience and Competencies
- Exhibit strong leadership skills (Applies to Level 3)
- Mentor and guide co-workers (Applies to Level 3)

PREFERRED COMPETENCIES

Preferred Job Skills
- Advanced skill in word processing, spreadsheet and database software (Applies t

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