Blue Cross Blue Shield of Georgia is a proud member of the WellPoint family of companies. At BCBS of Georgia, we are dedicated to improving the lives of the people we serve and the health of our communities.
Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
Provider Network Mgr Sr
Develops the provider network through contract negotiations, relationship development, and servicing. Primary focus of this role is contracting and negotiating contract terms. Typically works with the most complex providers at least 50% of the time. Complex providers may include, but are not limited to institutional providers, large medical groups and ancillary providers, providers in areas with strong competition or where greater provider education around managed care concepts is required. Contracts involve non-standard arrangements that require a high level of negotiation skills. Fee schedules are often customized. Primary duties may include, but are not limited to: Serves as key resource for other contracting staff and provides mentoring and on-the-job training and development. May serve as lead over a contracting team engaged in less complex negotiations. Works independently and requires high level of judgment and discretion. May work on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management. May collaborate with sales team in making presentations to employer groups. Serves as a communication link between professional providers and the company. Conducts more complex negotiations and drafts documents. May prepare financial projections and conduct analysis.
Requires a BA/BS degree; 5-7 years experience in contracting, provider relations, provider servicing; experience should include prior contracting experience; or any combination of education and experience, which would provide an equivalent background. H ospital, PHO, large group contracting experience required. Experience with transplant contracting and capitated reimbursement preferred. Negotiation experience with Accountable Care Organizations a plus, but not required. Requires travel.
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