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:
- 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.
- Bachelors degree in business or healthcare or relevant field or equivalent work experience required
- 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.
- 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.
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.