Blue Cross and Blue Shield of Kansas
Provider Relations Representative
Blue Cross and Blue Shield of Kansas, Topeka, Kansas, United States, 66652
Under the supervision of the Provider Relations Manager and in collaboration with the Director of Provider Relations, the Provider Relations Representative I is responsible for establishing relationships with Blue Cross and Blue Shield of Kansas (BCBSKS) in‑network providers and health systems, educating them on new policies, procedures, and lines of business, and discussing claim issues, trends, and reimbursement for all lines of business.
Why Join Us
Make a positive impact on the health and well‑being of Kansans.
Dynamic work environment: collaborate with a team of passionate and driven individuals.
Trust: work for one of the most trusted companies in Kansas.
Stability: 80 years of commitment, compassion and community.
Compensation Salary range: $73,920 – $92,400 (Exempt, 15 days).
What you’ll do
Develop and maintain ongoing working relationships with providers.
Schedule regular cadence of in‑person and virtual provider visits.
Serve as a provider advocate and liaison between providers and BCBSKS, collaborating with internal staff to resolve problems.
Keep providers informed in all programs administered by BCBSKS.
Evaluate redetermination requests and, when appropriate, submit requests for reconsideration to management.
Conduct provider workshops, webinars, and teleconferences to educate providers and/or their office staff.
Conduct case reviews of members and other audits as requested.
Assist providers in all aspects of contract requirements and claims submission.
Responsible for provider contracting, reimbursement, and potential negotiations for all BCBSKS lines of business.
Contribute to educational material and manuals for facility and professional providers.
Coordinate implementation of new programs and procedures with providers.
Regularly attend and represent BCBSKS at external community events and programs.
What you need Knowledge / Skills / Abilities
Basic background and knowledge in facility and professional provider contracting.
Valid driver’s license.
General ability to analyze contract language, identify discrepancies and recommend changes.
Basic human relations, oral and written communication skills.
Strong computer skills to operate effectively with company systems.
General ability to analyze pertinent health system/provider financial and reimbursement information.
Basic working knowledge of claim billing procedures for Blue Cross, TriWest and/or Medicare Advantage and claim coding practices (ICD‑10, revenue codes, HCPCS and/or CPT‑4).
Basic knowledge of coverage guidelines to include local medical review policy criteria.
General ability to understand medical practices of all providers.
Basic knowledge of programs administered by BCBSKS and 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.
Must support and exhibit BCBSKS values: integrity, dependability, service, growth, progress, and courage.
Education and Experience High school diploma or equivalent required. Bachelor’s degree in general business, accounting, marketing or hospital administration/health economics strongly preferred. If no degree, a minimum of three years of experience in a related field is required. Comprehensive knowledge of procedural and diagnostic coding highly preferred; certification by the American Academy of Procedural Coders preferred.
Seniority level Entry level
Employment type Full‑time
Job function Health Care Provider
Industries Insurance
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Why Join Us
Make a positive impact on the health and well‑being of Kansans.
Dynamic work environment: collaborate with a team of passionate and driven individuals.
Trust: work for one of the most trusted companies in Kansas.
Stability: 80 years of commitment, compassion and community.
Compensation Salary range: $73,920 – $92,400 (Exempt, 15 days).
What you’ll do
Develop and maintain ongoing working relationships with providers.
Schedule regular cadence of in‑person and virtual provider visits.
Serve as a provider advocate and liaison between providers and BCBSKS, collaborating with internal staff to resolve problems.
Keep providers informed in all programs administered by BCBSKS.
Evaluate redetermination requests and, when appropriate, submit requests for reconsideration to management.
Conduct provider workshops, webinars, and teleconferences to educate providers and/or their office staff.
Conduct case reviews of members and other audits as requested.
Assist providers in all aspects of contract requirements and claims submission.
Responsible for provider contracting, reimbursement, and potential negotiations for all BCBSKS lines of business.
Contribute to educational material and manuals for facility and professional providers.
Coordinate implementation of new programs and procedures with providers.
Regularly attend and represent BCBSKS at external community events and programs.
What you need Knowledge / Skills / Abilities
Basic background and knowledge in facility and professional provider contracting.
Valid driver’s license.
General ability to analyze contract language, identify discrepancies and recommend changes.
Basic human relations, oral and written communication skills.
Strong computer skills to operate effectively with company systems.
General ability to analyze pertinent health system/provider financial and reimbursement information.
Basic working knowledge of claim billing procedures for Blue Cross, TriWest and/or Medicare Advantage and claim coding practices (ICD‑10, revenue codes, HCPCS and/or CPT‑4).
Basic knowledge of coverage guidelines to include local medical review policy criteria.
General ability to understand medical practices of all providers.
Basic knowledge of programs administered by BCBSKS and 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.
Must support and exhibit BCBSKS values: integrity, dependability, service, growth, progress, and courage.
Education and Experience High school diploma or equivalent required. Bachelor’s degree in general business, accounting, marketing or hospital administration/health economics strongly preferred. If no degree, a minimum of three years of experience in a related field is required. Comprehensive knowledge of procedural and diagnostic coding highly preferred; certification by the American Academy of Procedural Coders preferred.
Seniority level Entry level
Employment type Full‑time
Job function Health Care Provider
Industries Insurance
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