Provider Network Consultant Assignments | Blue Cross and Blue Shield of Illinois (2024)

FAQs

What does a provider network consultant do? ›

Professional Provider Network Consultants

The PNC team assigned to your territory specializes in investigating issues, producing data and developing solutions. If needed, a PNC can visit your office to help address any special needs or concerns.

If you need to add a provider to your current contracted group, complete the Provider Onboarding Form. Once the form and credentialing requirements are complete, we will appoint the provider into the network and send a letter to the contracted group. Credentialing can take 30 to 120 days.

The Network Relations Consultant develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.

Network Consultants analyze, test, troubleshoot, and evaluate existing network systems, such as local area networks (LAN), wide area networks (WAN), cloud networks, servers, and other data communications networks. Perform network maintenance to ensure networks operate correctly with minimal interruption.

"In-network" means that a provider is credentialed with a given insurance company, and is eligible to submit claims for reimbursem*nt. Being in-network allows patients with primary insurance coverage to access the provider's services at negotiated rates, potentially reducing their out-of-pocket expenses.

The insurance company will contact the license board, college registrars' offices, and past employers to verify your information. This can take a significant amount of time especially if the credentialing department can't confirm the information on the first attempt.

We typically see the credentials verification process completed in 60 – 90 days and the contracting phase complete in another 30 days for a total of 90 – 120 days from the time an insurance company receives the providers credentialing application.

Blue Cross Blue Shield is the best health insurance company in Illinois. Its cheapest Silver plan costs $379 per month before discounts. Currently insured?

What is provider network insurance? ›

A provider network is a list of doctors, other health care providers, and hospitals that a plan contracts with to provide medical care to its members. They're known as “network providers” or “in-network providers.” A provider that isn't contracted with the plan is called an “out-of-network provider.”

Health Care Service Corporation

Blue Cross Blue Shield of Illinois / Parent organization

Network consultants typically work to help organizations build and maintain computer networks that meet their needs. They often use their networking expertise to help organizations stay up to date on new technology and other information technology issues.

The Senior Network Consultant (SNC) will work in a fast-paced environment helping clients achieve optimal use of their workstations, servers, networks, and peripherals by performing needs analysis, procurement support, installation, training, and problem resolution.

Provider relations representatives are the main point of communication between healthcare providers and insurance companies. They can answer questions or address complaints via phone calls and may host meetings about insurance information.

Coordinates network provider submissions, such as, provider applications and network agreements to internal systems and departments. Primary duties may include, but are not limited to: Supports all Field Representatives to obtain agreements, Credentialing and Health Plan request documentation.

Provider Network Managers Overview & Description

Review system and application logs and verify completion of scheduled jobs, including system backups. Analyze network and server resource consumption and control user access. Install and upgrade software and maintain software licenses.

A provider network is a list of doctors, other health care providers, and hospitals that a plan contracts with to provide medical care to its members. They're known as “network providers” or “in-network providers.” A provider that isn't contracted with the plan is called an “out-of-network provider.”

A network service provider (NSP) is a business entity that provides or sells services such as network access and bandwidth by allowing access into its backbone infrastructure or access to its network access points (NAP), which consequently also means access to the Internet.