Responsible for the contracting, credentialing, and maintenance of professional provider data to support marketing, membership and network contracting across all lines of business.
Building relations with the provider community.
Promoting high quality initiatives to support data integrity.
Accepting ownership and leading highly specialized operational and customer support duties that require independent initiative.
Participating in internal provider meetings and work groups.
Researching problems related to provider credentialing, data and network participation.
Providing training and education to all Blue Cross contracted providers including hospitals, physicians, and other allied professional providers.

Bachelor’s Degree and three (3) years of work experience in managed care OR a minimum of five (5) years work experience in a managed care environment.
Two (2) years of healthcare administration experience in clinical and financial settings, with direct provider communication experience.
Effective interpersonal, analytical, presentation and communication skills.
Knowledge of the healthcare industry, healthcare systems and payer/provider dynamics.
Ability and willingness to travel within assigned areas for responsibility, including overnight stays.
Strong comprehension of contracts, applications, and products.
Understanding of provider reimbursement methodologies and claims.
Working knowledge of claims processing systems.
Effective organizational and planning skills with the ability to take initiative and work independently.
Demonstrated ability to meet deadlines and work well under pressure.
Clear and concise interpersonal, verbal and written communication skills.
Collaboration skills resulting in business/process improvements/changes.
PC proficiency and skills to include Word, Excel, PowerPoint, etc.
Strong facilitation, presentation and analytical skills.

Provider Relations Representative

Key skills