Blue Cross of Idaho Provider Relations Rep - Sr (Couer D'Alene) - 1967 in Coeur d'Alene, Idaho

This job was posted by https://idahoworks.gov : For more information, please see: https://idahoworks.gov/ada/r/jobs/1128348 Position Description &br&n&br& Work independently to serve as the liaison and maintain open communication between Blue Cross of Idaho (BCI) and the providers of healthcare services regarding company policies and payment procedures. Train and educate providers on BCI's fee-for-service and value based contracts as well as the requirements and procedures associated with the contracts. Heavy day travel within local area required. &br& &br& Position Requirements &br&n&br&n&&Experience:&& &br& o Four years provider service experience; OR&br& o Five years healthcare industry experience (to include billing, claims processing, provider relations, or customer service)&br& • Certifications/Licenses: Certified Professional Coder (CPC) certification OR must obtain coding certification within one year of date of hire&br&n&br&n&&Knowledge, Skills and Abilities (KSAs):&&n&br&n&br&n&&Knowledge of:&& &br& • Insurance benefit structures&br& • Provider and member contract language&br& • Claim detail of remittance procedures, procedures associated with healthcare provider business offices and other matters related to internal operations; claims processing and clinical editing&br& • Blue Cross of Idaho provider portal&br& • Provider office workflows&br& • Blue Cross of Idaho's EDI and the use of online electronic capabilities for claims inquiry, eligibility, authorization submission and claims submission&br& • Provider contracts, agreement configuration, fee schedules, and QHP tailored networks&br& • Medical terminology&br& • Health insurance industry&br& • Inter-Plan teleprocessing (ITS) and Federal Employee Health Benefits Program (FEP) requirements&br& • Internal, external, operational and professional policies&br& • Knowledge of programs such as HEDIS, STARs, and NCQA&br&n&br&n&&Skills:&& &br& • Microsoft Office - (Word, Excel, Outlook, PowerPoint) - Basic &br& • Organizational and time management&br& • Interpersonal, verbal and written communication&br& • Problem solving/analytical &br& • Coding (CPT, ICD, HCPCS) &br& • Internet and intranet navigation&br& • Business/technical writing&br&n&br&n&&Ability to:&& &br& • Attend meetings and trainings beyond regular working hours&br& • Extensive day travel within local area&br& • Host training seminars and attend conferences&br& • Influence and educate in a clear and concise manner&br& • Effectively manage relationships with providers&br& • Communicate effectively and professionally with a variety of individuals both internal and external&br& • Complete assigned tasks&br& • Research and navigate web-based programs&br& • Work with changing priorities&br& • Make decisions independently and be self-motivated&br&n&br&n&&Preferred Qualifications:&&n&br& • Experience with Facets, Inter-Plan Teleprocessing Services (ITS) and/or the Federal Employee Program&br& • Knowledge of provider contracts, agreements, and tailored network arrangements&br& • Knowledge of Medicare/Medicaid programs&br& • Knowledge of Facets, BlueCard, and FEP Direct systems&br& &br& Reports to: Supervisor, Provider Relations&br& Salary Grade: 15&br& Internal Job Posting Dates: 10/12/2018 -10/19/2018&br& External Job Posting Dates: 10/12/2018 - Until Filled&br&n&br&We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. &br&