Senior Provider Relations Representative - Remote in Austin Texas

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.

Job Summary

This position is based in Austin Texas and is responsible for providing support, as well as developing and maintaining cooperative working relationships with providers while facilitating and enhancing provider ease of doing business with HCSC. This includes establishing and maintaining provider relationships to support network performance, serving as a resource and point of escalation for provider concerns, issue tracking and resolution, educating and training providers, identifying trends, and evaluating provider performance to ensure operational and financial requirements are met.

Required Job Qualifications: Bachelor’s degree in business OR 6 years leadership experience. 4 years’ experience in claims, customer service, physician office or hospital or healthcare environment. 3 years’ experience in a position which requires in-depth physician/provider relations, including but not limited to, contracting and reimbursement issues.

Ability to negotiate and contract with healthcare providers. Platform skills; organizational and planning skills; and ability to take initiative and work independently. Ability to multi-task; meet deadlines and work well under pressure. Ability and willingness to travel within assigned areas of responsibility, including overnight stays.

PC proficiency to include Microsoft Office Preferred Job Qualifications: Extensive Medicare and Medicaid claims experience, including demonstrated expertise interpreting claims outcomes, resolving claim issues, and navigating government program requirements. Advanced knowledge of healthcare claims processing systems and claims workflows, with the ability to investigate, analyze, and resolve complex provider claim issues.

Strong understanding of provider reimbursement methodologies, payment policies, and financial impacts affecting provider organizations. Demonstrated success building and maintaining relationships with physician groups, hospitals, health systems, and provider leadership. Experience working with healthcare contracting, reimbursement methodologies, provider network operations, and managed care environments.

Experience conducting provider education, training sessions, presentations, and face-to-face provider consultations. Knowledge of BCBSTX claims processing systems preferred. Client-site Location: This is a field-based position in the Austin Texas market that requires provider office visits. Sponsorship: Sponsorship is not available #LI-KW1 #INAK 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. This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii .

HCSC Employment Statement: 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.

We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law. Base Pay Range $63,300.00 - $114,300.00 Exact compensation may vary based on skills, experience, and location.