Healthcare Provider Relations Specialist I/II

2 weeks ago

Meridian, Idaho, United States Blue Cross of Idaho Health Service, Inc. Full time


Blue Cross of Idaho Health Service, Inc. is seeking a dedicated Provider Relations Representative to operate autonomously as the intermediary and maintain effective communication between the organization and healthcare service providers concerning company policies and payment protocols.

This role involves training and informing providers about BCI's fee-for-service and value-based agreements, along with the associated requirements and procedures.

**Travel Requirements:** Frequent travel is essential for this position.

**Ideal Candidate Profile:**

Provider Relations Rep I:

**Experience:** 4 years in provider services or healthcare industry experience
**Education:** High School diploma or equivalent

Provider Relations Rep II:

**Experience:** 8 years in provider services or healthcare industry experience
**Education:** High School diploma or equivalent

**Key Responsibilities:**
- Manage the resolution of provider contracts, agreements, fee schedules, and payment discrepancies.
- Collaborate with essential stakeholders to identify and address issues.
- Oversee the resolution of contract or agreement challenges.
- Communicate critical issues and provide recommendations to leadership.
- Educate providers on policies, procedures, practices, and data accuracy.
- Ensure providers are updated on changes to policies, procedures, and practices.
- Guarantee compliance with regulatory agencies for both the department and providers.
- Coordinate cross-departmental activities and projects to support provider contract requirements.
- Conduct research to respond to inquiries and interpret policies and procedures for effective responses.
- Provide introductory information to newly contracted providers.
- Encourage provider participation in online tools and programs available.
- Undertake additional duties and responsibilities as assigned.

**Accommodations:** To perform this role successfully, an individual must be able to execute each essential duty satisfactorily. The requirements listed above represent the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment based on race, color, sex, age, national origin, religion, sexual orientation, gender identity, veteran status, disability, or any other protected class.

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