Provider Relations Representative I (Hybrid)

Purpose This role ensures a seamless provider experience by acting as the primary liaison between Health Services stakeholders and the company. The incumbent will manage all CareFirst contracted in‑network providers, including independent professional practices, health systems, hospitals, and ancillary providers across all lines of business. The position requires hybrid work, with a portion of the week in the office and a portion from home. Responsibilities Relationship Management: Establish and maintain relationships with providers and stakeholders, ensuring regular communication and timely problem resolution. Leverage relationships to influence provider behavior toward favorable outcomes and support corporate initiatives. Training and Education: Provide targeted training and education to the provider community to ensure effective use of electronic tools, provider portal, and established processes. Partner with the Provider Training and Education Department to engage providers in program value. Issue Resolution: Research, resolve, and support escalated service‑related issues. Coordinate among multiple parties across CareFirst, identify root causes, and provide timely responses via virtual or face‑to‑face visits, correspondence, email, or phone. Project Management: Support network projects and outreach initiatives that mitigate risk, supplement technology, maintain critical operations, and support corporate initiatives such as provider experience scores, STAR ratings, HEDIS measures, and CAHPS program. Qualifications Education Level: Associate’s Degree or, in lieu of the degree, an additional two years of relevant work experience. Experience: 2 years with CareFirst computer systems or comparable technology platforms, networks, products, policies, and procedures, including provider, training, customer service, and claims processing experience. Preferred Qualifications: Bachelor’s Degree in business, healthcare administration, or related industry. Knowledge, Skills, and Abilities (KSAs): Working knowledge of provider billing and coding mechanisms, including special pricing, medical terminology, CPT coding, and CMS‑1500 or CMS‑UB‑04 claim formats. Knowledge of managed‑care industry regulatory requirements, health‑care financial matters, and third‑party payment methodologies. Previous experience at CareFirst, an insurance plan, a hospital, or a physician hospital organization (PHO). Understanding of contractual documents and ability to communicate terms to providers. Proficiency with Microsoft Excel, Access, PowerPoint, and Word. Ability to determine priorities, meet deadlines, self‑motivate, and manage competing priorities. Excellent written and verbal communication and customer‑service skills. Problem‑solving ability, critical thinking, and analytical skills. Conflict resolution skills for client‑facing roles. Effective presentation and facilitation abilities. Consistent communication to meet service‑excellence expectations. Travel Requirements Estimated 50% frequent travel to provider offices, hospitals, and medical offices. Compensation Salary range: $49,464 – $98,241. The disclosed range is a general estimate and may vary based on factors such as scope of responsibility, experience, education, internal equity, and location. In addition to base salary, CareFirst offers a comprehensive benefits package, incentive programs, and 401(k) contributions (subject to eligibility). Benefits Health, dental, and vision insurance. Paid time off and holidays. Retirement savings plan with company match. Performance‑based incentive plans. Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. The company provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran status, disability, or genetic information. Compliance and Physical Demands The incumbent is required to disclose any debarment, exclusion, or other event that disqualifies them from federal health‑care program work. The role is primarily seated, with occasional walking or standing, use of hand, frequent speaking and hearing, and occasional lifting of up to 25 pounds. Eligibility Must be eligible to work in the U.S. without sponsorship. #J-18808-Ljbffr