Network Development Representative
Less than 5 years experience • Healthcare IT
Bachelor’s degree in a related field required. Four years of related health care experience may be used in lieu of degree.
Minimum of three years of experience in the health care industry focusing on the establishment and maintenance of hospital and facility managed care contractual agreements, face-to-face interaction and business relationships with providers in a managed care setting and managed care hospital and facility contracting experience is required. Managed care contracting experience with other provider types is preferred.
Excellent written and oral communication skills, including well-defined and proven public speaking skills.
Excellent interpersonal skills and proven complex negotiating skills to address and handle all provider contacts, proven hospital/facility contract negotiations and problem resolution with tact and diplomacy.
Must have ability to prioritize and handle multiple competing responsibilities with successful outcomes.
Must have proven problem solving skills and ability to independently analyze and dissect provider contracts, relationships and issues and create workable win-win solutions for both the provider and BCBSLA.
Must have proficient skills using PC based applications to develop and report on provider activity using Microsoft Word, Excel, PowerPoint and Outlook. Firsthand knowledge and experience with the Emptoris Contract Management System is preferred.
Must have ability to respond quickly to requests for provider on-site visits.
Must have dependable transportation and be willing to travel frequently throughout the state as necessary.
Must maintain professionalism at all times and represent BCBSLA in an appropriate manner.
Builds effective provider networks by independently negotiating contractual language and competitive reimbursement with all provider types that pose a mid to high level degree of difficulty to ensure consistency with corporate goals and budget.
Acts as a professional resource to answer all contractual questions posed by providers and/or internal departments within the organization, including but not limited to, assisting providers with difficult problems unable to be resolved through normal/available channels, participating in dispute resolution process for providers in assigned territory according to Network Policy and Procedure, participating as appropriate for in-services and workshops, and call on network providers on a regular basis or as needed, to help ensure provider contract compliance and provider satisfaction.
Provides clear, concise and timely reporting to management and/or other plan personnel regarding the progress of provider network development including monitoring and reporting significant developments and changes to key administrative provider contacts occurring within the provider community to management to ensure the company is appropriately advised and strategically aligned on network issues.
Acts as point of contact for providers by monitoring and overseeing the implementation of providers in the network as well as the provision of the materials and paperwork necessary to participate in networks to ensure efficiencies, provider satisfaction and goals of the department for timely set up are met.
Maintains current information on all aspects of assigned market including our plan’s competitive position within the market and working within the organization to insure adequate and appropriate provider access for our members.
Works in conjunction with all internal departments to help maintain the Blue Cross market share.
Engages providers in participation of applicable corporate initiatives to ensure appropriate audiences are informed accurately and timely.
Maintains current knowledge of URAC accreditation requirements for Network to help obtain or exceed departmental, divisional and/or company goals.
The physical demands described here are representative of those that must be met by an employee to successfully perform the accountabilities (essential functions) of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.