Provider Network Consultant

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

**This is a Flex (Hybrid) role: 3 days in office; 2 days remote**

Required Job Qualifications:
*Bachelor’s degree in health care or business administration or a minimum of 4 years work experience in a managed care environment.
*Minimum of 2 years of health care administration experience in clinical and financial settings, with direct provider communication experience.
*Effective interpersonal, analytical, presentation and communication skills.
*Knowledge of the health care industry and BCBSIL private business.
*Ability and willingness to travel within assigned areas for responsibility, including overnight stays.
*Extensive knowledge of contracts, applications, and products.
*Demonstrated proficiency in provider reimbursement methods.
*Working knowledge of claims processing systems.
*Effective organizational and pla

*Knowledge of ICD-10, CPT, HCPCS and revenue codes

*COB (Coordination of Benefits)and overpayment knowledge

*Familiar with Medicare, Medicaid and Commercial payer rules

*Experience identifying and resolving complex claims issues and trends

*Proven ability to analyze root cause and recommend improvements

*Experience supporting cross functional teams which include Provider Relations, *Customer Service and Claims

*Strong verbal and written communication skills, especially in claims logic

*The ability to train staff on claims processes and workflows

nning skills.
*Ability to take initiative and work independently.
*Demonstrated ability to meet deadlines and work well under pressure.
*Working knowledge of software, including Microsoft Office

Preferred Job Qualifications:

*Knowledge of ICD-10, CPT, HCPCS and revenue codes

*COB (Coordination of Benefits)and overpayment knowledge

*Familiar with Medicare, Medicaid and Commercial payer rules

*Experience identifying and resolving complex claims issues and trends

*Proven ability to analyze root cause and recommend improvements

*Experience supporting cross functional teams which include Provider Relations, Customer Service and Claims

*Strong verbal and written communication skills, especially in claims logic

*The ability to train staff on claims processes and workflows

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.