Provider Network Manager in Memphis, TN

$150K - $200K(Ladders Estimates)

BlueCross BlueShield of South Carolina   •  

Memphis, TN 38101

Industry: Finance & Insurance

  •  

5 - 7 years

Posted 54 days ago

Maintains relationships with providers by daily interaction and delivers technical assistance to correct any errors and control risks for the insurer and provider.Job Description:

Job Responsibilities

  • Implementing processes and changes needed to maintain regulatory compliance, contract compliance or to improve quality.
  • Implementing and monitoring provider programs and special contracts; supervising enrollment processing.
  • Leading data reporting and analysis projects to monitor financial and service relations with providers.
  • Consulting with providers on delivery, training and support related issues; identifying opportunities for enhancement and recommending solutions.

Job Qualifications

Education

  • Bachelors degree in business or healthcare or relevant field or equivalent work experience required

Experience

  • 1 year - Experience in provider relations and network development with a proven track record of successfully closing negotiations with aggressive timelines while minimizing financial exposure; must possess overall industry knowledge as well market appropriate knowledge of the region of responsibility.
  • 5 years - Experience in provider contracting with emphasis on healthcare education and reimbursement, contract negotiations inclusive of both contract language and financial impact.

Skills\Certifications

  • Ability to speak in public and conduct effective presentations.
  • Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
  • Demonstrated ability to interpret and translate technical and/or or complex concepts into information meaningful to project team members and/or business personnel.
  • Proficient in MicroSoft Office (Outlook, Word, Excel, Access and Powerpoint)
  • Accuracy and attention to detail
  • Effective time management skills
  • Excellent oral and written communication skills
  • Strong interpersonal and organizational skills
  • Strong analytical skills
  • Ability to manage multiple projects and priorities
  • Positive attitude, self-driven, engaging, proactive, results drive
  • Knowledge in Medical terminology
  • Knowledge of contract language and reimbursement methodologies, managed care business processes, case-mix adjustment, medical terminology, utilization management and applications for claims payment, required.

License

  • Valid Driver's License

Job Specific Requirements:

Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver's license, auto insurance compliance with minimum liability requirements; as defined in the "Use of Non BCBST-Owned Vehicle" Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).

*The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.

Valid Through: 2019-10-18