To facilitate positive, professional relationships with BCBST providers and with BCBST through proactive communication, education and problem resolution.
Job Duties & Responsibilities
Proactively serve and educate contracted providers, physicians, hospitals, ambulatory surgery centers, ancillary, organizational, and health care practitioners on preferred BCBST policies, procedures, technologies and contractual obligations through site visits and workshops. Network Manager I employees typically manage medium to large providers
Evaluate needs, identify targets, contract with providers and participate in facility and ancillary negotiations determined to be nonstandard within the assigned territory, to ensure adequate networks for each BCBST product line based on established adequacy and reimbursement targets.
Assists in preparation for contracting meetings by pulling data together; may present at contracting meeting.
Facilitate sessions and act as designated speaker by presenting training at provider workshops
Collaborate with internal divisions, including but not limited to: Healthcare Services, Marketing and Customer Service, to understand and participate (where appropriate) all issues related to providers and healthcare community within assigned territory. Represent department in cross-functional projects and other internal initiatives.
Lead ongoing operations meetings with high level physician groups and/or facilities when appropriate
Evaluate network needs, identify targets and coordinate the contract needs for standard provider contracts through the Network Representative and PSO to ensure adequate networks for each BCBST product line based on established adequacy and reimbursement targets.
Consult with provider partners on preferred business practices to assist with the effective management of BCBST members.
Facilitate interaction between providers and appropriate BCBST departmental staff for clarification or correction of major provider concerns and/or issues; follow issue through to resolution with subject matter experts and close issues/inquiries out with the provider.
Maintain routine contacts with critical provider partners within assigned territory.
Manages own calendar; conducts analyses and makes recommendations on next steps. Works independently on most routine activities. Seeks counsel from management and/or senior staff members on non-standard issues, projects, and initiatives
Seek opportunities to participate in healthcare community, where BCBST representation can enhance long-term relationships with our provider partners.
Bachelor’s Degree in Business or Healthcare Administration or equivalent work experience required. Equivalent years of experience are defined as a year of professional experience for every year of college requested.
Minimum 3 years experience in healthcare industry required.
Experience with provider contracting in the health care industry strongly preferred.
Exposure to medical terminology, contract language and reimbursement methods
Completion of AHIP Academy for Healthcare Management (AHM) courses preferred – 1.) Healthcare Management: An Introduction, 2.) Network Management, 3.) Medical Management, and 4.) Health Plan Finance & Risk Management
PAHM coursework preferred
Ability to maintain high level of professionalism by demonstrating excellent written and verbal communication skills with both internal and external customers.
Persuasive presentation skills required.
Self-motivated and able to manage multiple tasks and priorities within specified timeframes.
Strong computer skills, to include word processing, spreadsheet and database management.
Strong organizational skills and attention to detail required.
Able to work independently and as part of a team.
Able to travel to provider offices.
BlueCross BlueShield of Tennessee - 19 months ago
BlueCross BlueShield of Tennessee (BCBST) is the oldest and largest not-for-profit managed care provider in the state of Tennessee....