Blue Cross and Blue Shield of Kansas
Provider Relations Representative
Blue Cross and Blue Shield of Kansas, Wichita, Kansas, United States, 67232
Join to apply for the
Provider Relations Representative
role at
Blue Cross and Blue Shield of Kansas
Under the supervision and direction of the Provider Relations Manager, 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 on new policies, procedures and lines of business as well as discussing claim issues, trends and reimbursement for all lines of business.
Why Join Us
Make a Positive Impact – your work directly contributes to 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 $73,920 – $92,400 salary (Exempt 15). The range is a good‑faith estimate and may vary based on qualifications.
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.
Keep providers informed in all programs administered by BCBSKS.
Evaluate redetermination requests submitted by providers 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 and required.
Assist providers in all aspects of contract requirements and claims submission.
Be responsible for provider contracting, reimbursement, and potential negotiations for all BCBSKS lines of business.
Contribute to educational material and manuals developed for facility and professional providers.
Coordinate implementation of new programs and procedures with providers.
Regularly attend and represent BCBSKS in external community events and programs.
What You Need – Knowledge, Skills & Abilities
Basic background and knowledge in facility and professional provider contracting preferred.
Valid driver’s license.
General ability to analyze contract language, identify possible discrepancies and recommend changes as appropriate.
Basic human relations skills and oral and written communication skills.
Strong computer skills to operate effectively with company systems and programs.
General ability to analyze pertinent health system/provider financial and reimbursement information for in‑depth analysis.
Basic working knowledge of claim billing procedures for Blue Cross, TriWest and/or Medicare Advantage including claim coding practices, ICD‑10 diagnosis and procedure codes, revenue codes, HCPCS codes and/or CPT‑4 codes.
Basic knowledge of coverage guidelines to include local medical review policy criteria.
General ability to understand medical practices of all providers to include knowledge of newly developed procedures and technology.
Basic knowledge of programs administered by BCBSKS.
Basic knowledge 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 the BCBSKS values of integrity, dependability, service, growth and 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. In lieu of the degree, a minimum of 3 years’ experience in a related field is required. Comprehensive knowledge and understanding of procedural and diagnostic coding strongly preferred. Certification by the American Academy of Procedural Coders preferred. General knowledge of all Blue Cross and Blue Shield lines of business strongly desired.
Job Details
Seniority level: Entry level
Employment type: Full‑time
Job function: Health Care Provider
Industries: Insurance
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Provider Relations Representative
role at
Blue Cross and Blue Shield of Kansas
Under the supervision and direction of the Provider Relations Manager, 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 on new policies, procedures and lines of business as well as discussing claim issues, trends and reimbursement for all lines of business.
Why Join Us
Make a Positive Impact – your work directly contributes to 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 $73,920 – $92,400 salary (Exempt 15). The range is a good‑faith estimate and may vary based on qualifications.
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.
Keep providers informed in all programs administered by BCBSKS.
Evaluate redetermination requests submitted by providers 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 and required.
Assist providers in all aspects of contract requirements and claims submission.
Be responsible for provider contracting, reimbursement, and potential negotiations for all BCBSKS lines of business.
Contribute to educational material and manuals developed for facility and professional providers.
Coordinate implementation of new programs and procedures with providers.
Regularly attend and represent BCBSKS in external community events and programs.
What You Need – Knowledge, Skills & Abilities
Basic background and knowledge in facility and professional provider contracting preferred.
Valid driver’s license.
General ability to analyze contract language, identify possible discrepancies and recommend changes as appropriate.
Basic human relations skills and oral and written communication skills.
Strong computer skills to operate effectively with company systems and programs.
General ability to analyze pertinent health system/provider financial and reimbursement information for in‑depth analysis.
Basic working knowledge of claim billing procedures for Blue Cross, TriWest and/or Medicare Advantage including claim coding practices, ICD‑10 diagnosis and procedure codes, revenue codes, HCPCS codes and/or CPT‑4 codes.
Basic knowledge of coverage guidelines to include local medical review policy criteria.
General ability to understand medical practices of all providers to include knowledge of newly developed procedures and technology.
Basic knowledge of programs administered by BCBSKS.
Basic knowledge 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 the BCBSKS values of integrity, dependability, service, growth and 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. In lieu of the degree, a minimum of 3 years’ experience in a related field is required. Comprehensive knowledge and understanding of procedural and diagnostic coding strongly preferred. Certification by the American Academy of Procedural Coders preferred. General knowledge of all Blue Cross and Blue Shield lines of business strongly desired.
Job Details
Seniority level: Entry level
Employment type: Full‑time
Job function: Health Care Provider
Industries: Insurance
#J-18808-Ljbffr