Provider Network Manager - Nashville
BlueCross BlueShield of Tennessee - Nashville, TN

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This position manages relationships with multiple healthcare and non-healthcare providers of all sizes throughout the state. The incumbent is to facilitate positive, professional relationships between a diverse provider base and BCBST through proactive communication, education and problem resolution. Responsibilities may increase with the incumbent’s demonstrated competence and tenure.

Job Duties & Responsibilities

Manage all CHOICES provider relationships from national providers to small independent offices.

Partner with providers on training opportunities, collaborate with Ancillary Network Development to develop training materials, and perform training for scheduled provider workshops and meetings

Facilitate contracting/credentialing/consulting/education/problem resolution/routine contacts with critical partners throughout the state.

Analyze data prior to contracting meetings; present at contracting meetings.

Assess network need to drive targeted provider participation.

Work with Ancillary Network Development to ensure that TennCare Bureau mandated provider network minimums are met and maintained throughout the state.

Partner with Ancillary Network Development to ensure change notifications, corporate contract additions, and provider updates are addressed statewide.

Coordinate the collection of provider data elements for special projects and reporting with Ancillary Network Development and appropriate divisions/departments within BCBST.

Conducts analyses and makes recommendations on next steps. Requires minimal level of counsel and direction from management.

Actively participate in healthcare community where BCBST representation can enhance long-term relationships with our partners.

Conduct state mandated and NCQA mandated credentialing and recredentialing provider site visits using BCBST credentialing guidelines within required timeframes.

Qualifications

Education

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.

Experience

Minimum 3 years experience in network management, provider relation, credentialing, marketing and/or similar experience required.

Experience with provider contracting in the health care industry strongly preferred.

Experience with CHOICES CRA language preferred.

Skills/Certifications

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.

Familiar with medical terminology, contract language and reimbursement methods.

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 - 21 months ago - save job - block
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About this company
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BlueCross BlueShield of Tennessee (BCBST) is the oldest and largest not-for-profit managed care provider in the state of Tennessee....