Provider Relations Representative

About the role

HCSC is hiring a Provider Relations Representative in Springfield, Illinois. The role covers the contracting, credentialing and maintenance of professional provider data to support marketing, membership and network contracting across all lines of business, and builds relationships with the provider community. It is hybrid/flexible, with in-office presence three days per week.

Key responsibilities

• Promote high-quality initiatives that support data integrity and lead specialized operational and customer support work.
• Participate in internal provider meetings and work groups, and research problems related to provider credentialing, data and network participation.
• Train and educate Blue Cross contracted providers, including hospitals, physicians, surgery centers, substance abuse and psych facilities, VA hospitals and allied professionals.

Required profile

• Bachelor's degree and 3 years of managed care experience, or 5 years in a managed care environment.
• At least 2 years of health care administration experience in clinical and financial settings, with direct provider communication.
• Willingness to travel within assigned areas, including overnight stays.
• Preferred: experience analyzing provider performance metrics, supporting provider network initiatives, resolving complex multi-department issues, and using provider-facing reporting tools.

Required skills

• Knowledge of contracts, applications and products, and provider reimbursement methods.
• Working knowledge of claims processing systems.
• PC skills including Word, Excel and PowerPoint.
• Preferred: advanced Excel (pivot tables, data validation), claims/billing/coding basics (CPT, ICD-10), CRM or provider management systems, and experience with government agencies and advocacy groups.

What we offer

• Base pay range of $63,300 to $114,300, varying with skills, experience and location.
• Annual incentive bonus plan subject to its terms and conditions.
• Benefits such as health and wellness, 401(k), pension, paid time off, paid parental leave, tuition reimbursement and more.