The position manages the Provider Support Services unit within CHOICES. PSS supports Provider Relations and executive management with the resolution of issues and root cause analysis of issues that are presented to them from our network providers. This position is accountable for the operation that offers the providers an avenue to resolve issues that may not or can not be resolved at the service department level. The operation is designed to listen for ways to improve our products and service to all providers networked with BCBST.
Job Duties & Responsibilities
Manage the Provider Support Services staff, including performance reviews.
Responsible for proactively finding ways for the corporation to improve provider relations, by working closely with CHOICES staff, Regional Provider Relations, PSO Management, Provider Contracting and Reimbursement areas.
Responsible for proactive communication and education of providers and provider relations on business interaction, procedural and relationship issues.
Monitors the handling of provider issues so as to ensure accurate completion as well as satisfactory turnaround time based on department standards.
Oversee the total operation of the department to verify that the budget parameters are met on an ongoing basis.
Produce weekly, monthly and annual performance reports.
Meets on site and off site with provider group staff as part of our issue resolution and proactive education process.
Bachelor’s degree or equivalent work experience. Equivalent experience is defined as one year of professional experience for each year of college requested.
Minimum 5 years experience in healthcare industry required.
Minimum 3 years supervisory experience required.
Requires leadership characteristics in order to motivate a wide range of employees as well as handle the daily management decisions.
Requires working knowledge of claims administration.
Excellent communication and presentation
Solid Microsoft Office skills with emphasis in Excel and Access.
Exceptional project management skills.
BlueCross BlueShield of Tennessee - 2 years ago
BlueCross BlueShield of Tennessee (BCBST) is the oldest and largest not-for-profit managed care provider in the state of Tennessee....