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Blue Cross Blue Shield of Kansas Professional Relations Representative in Hutchinson, Kansas

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/12888915

Under the general direction of the Manager, Professional Relations has direct responsibility for individual provider contracting, education and services of the Professional Relations Department\'s programs.\ \ *This position will be located in the Hutchinson office. Applicants must live in or be willing to relocate to the area.

  • General Activities: Responsible for fostering a professional working relationship with professional providers to improve their knowledge of Blue Cross and Blue Shield and developing a relationship whereby the providers rely on Blue Cross and Blue Shield services, expertise, and financing systems. Responsible for contracting with new providers and coordinating all contracts and provide data changes through the contract specialists.
  • Planning and Organizing Activities: Maintains an ongoing itinerary of visits with professional providers\' offices to enhance the relationship between Blue Shield and these providers in order to meet the corporate objective of \"providing our subscribers with high quality health care at a reasonable cost.\"
  • Provider Visits: Responsible for direct field visitation and/or correspondence with providers of medical/dental services to review and resolve utilization and quality matters. Responsible for field contacts with providers to stress cost awareness, GAPS in care, risk adjustment and value-based activities with information reflecting the provider\'s pattern of practice in relation to local and statewide peers as well as global health care issues.
  • Administrative Activities: Assists with recommendations and guidance for internal development of utilization and integrity case development and reviews. Evaluates provider needs, attitudes, interests, and recommends methods or procedures to improve programs such as Community Networks and communications processes based upon these evaluations. Analyzes referrals and reports from claims areas and other organizational sources related to professional provider performance. Develops methods of improving performance as indicated by such referrals and reports.
  • Communication and Provider Training: Communicates with and orients new providers relative to all aspects of Blue Shield and its programs.
  • Traveling and Physical Requirements: Requires extensive travel including evening meetings and overnight stays up to or averaging two nights per week and/or 4-5 days per week. Requires a valid driver\'s license and ability to operate a motor vehicle for extensive periods of time.

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