Blue KC
Director, Contracting and Network Management
Blue KC, Kansas City, Missouri, United States, 64101
Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:
Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
Annual incentive bonus plan based on company achievement of goals
Time away from work including paid holidays, paid time off and volunteer time off
Professional development courses, mentorship opportunities, and tuition reimbursement program
Paid parental leave and adoption leave with adoption financial assistance
Employee discount program
Job Description Summary:
The Director, Contracting and Network Management is responsible for negotiation, execution, implementation, and administration of provider contracts with hospitals, physicians, and ancillary providers as assigned and all activities that support those efforts for all lines of business, including commercial and all Government Programs and related network management and expansion opportunities.
Job Description
Initiate and lead negotiations for network participation agreements related to all lines of business (commercial and Government Programs), including service area analysis, network development and strategy, and problem resolution.
Participate in the development of provider strategy to support contracting and network development efforts on behalf of Provider Services and Senior Management
Partner closely with leadership from key internal partners from Sales, Underwriting, Medical Economics, Product Development, Compliance, Legal, etc. in developing and implementing provider contracting and network development strategy to support medical cost improvement, market growth, compliance, and legal needs.
Direct Contracting Specialists work by assessing the priority of projects as they relate to the overall provider strategy and corporate goals.
Responsible for management and oversight of Provider Contracting Analytics Team, responsible for the analytic support of contract negotiations, pricing impacts, and network adequacy reporting.
Understanding and ability to communicate various payment methodologies for Hospital, Physician, and ancillary provider reimbursement.
Analyze and report financial impact of reimbursement or methodology changes, directing and evaluating analytics to support provider contracting negotiations.
Supports evaluation and resolution of complex business and technical problems and communicates complex information and developments to appropriate staff.
Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.
Participates in the development, modification and implementation of complex payment methodologies, from fee for service to value-based reimbursements, for various provider types. Makes recommendations and executes on new methodologies that link quality and price to reduce cost trend. Provides expert knowledge around Hospital, Physician, and Medical Home profiles and reimbursement including: ACO’s, bundled episodic payments, capitation, etc
Responsible for operationalizing contracts, including pricing, configuration, communication
Directs workflow by assessing the priority of projects as they relate to the overall provider contract and reimbursement strategy and corporate goals
Handles complex external contract negotiations with all provider types and direct management of vendor relationships and other outside resources associated with all lines of business and Governmental Programs. Acts as main point of contact between the vendor and the internal customer. Develops and implements detailed contract negotiation strategy, including face to face negotiations on multiple types of reimbursement methodologies
Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market
Provides project leadership to facilitate the implementation of new complex applications and complex enhancements of existing applications. Serves as project lead on system enhancements in provider services and network development. Provides oversight to team and technical lead on testing and implementation.
Minimum Qualifications
Bachelor’s degree in business administration, health care administration, computer science, or other relevant academic discipline; or an equivalent combination of education and experience
7 years of experience in healthcare and/or provider services operational processes
3 years of experience in a supervisory or lead capacity
Previous managed care network contracting experience associated with commercial or Government Programs
Fully comfortable understanding, explaining, and using computer processes and applications
Intermediate level keyboard skills
Extensive knowledge of and ability to use Microsoft Windows and Office applications such as Word, Excel, Access, and PowerPoint
Extensive knowledge of managed care processes and contracting
Extensive knowledge of specialized reimbursement methodologies
Skill in negotiating contracts and agreements
Extensive knowledge of FACETS modules, NetworX Pricer and Modeler. Directs workflow by assessing the priority of projects as they relate to the overall provider contract and reimbursement strategy and corporate goals.
Extensive knowledge of financial concepts.
Preferred Qualifications
Master's degree, J.D. or other advanced degree related to health care, finance or business administration
Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.
At Blue Cross and Blue Shield of Kansas City (Blue KC), we have long put our members first by developing products and services to meet their needs. From our founding in 1938 to more than 80 years of experience in innovative, patient-centered healthcare coverage, Blue KC continues to keep our members at the center of everything we do. As a market leader, we continue to embrace new ideas to make healthcare more affordable and to improve the customer experience. Come join us!
Blue Cross and Blue Shield of Kansas City will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully utilize electronic and online job application systems. For assistance, please send an email to Recruitingteam@bluekc.com .
EOE/Veterans/Disability
Affirmative Action Employer
E-Verify Participation (https://bluekcmemberportal.azureedge.net/pdf/2024/E-Verify_Participation_Poster_Eng_Es.pdf)
Equal Employment Opportunity/Nondiscrimination/Affirmative Action Policies
IER Right to Work (https://www.e-verify.gov/sites/default/files/everify/posters/IER_RightToWorkPoster%20Eng_Es.pdf)
FMLA
Employee Polygraph Protection Act (https://www.dol.gov/whd/regs/compliance/posters/eppac.pdf)
Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
Annual incentive bonus plan based on company achievement of goals
Time away from work including paid holidays, paid time off and volunteer time off
Professional development courses, mentorship opportunities, and tuition reimbursement program
Paid parental leave and adoption leave with adoption financial assistance
Employee discount program
Job Description Summary:
The Director, Contracting and Network Management is responsible for negotiation, execution, implementation, and administration of provider contracts with hospitals, physicians, and ancillary providers as assigned and all activities that support those efforts for all lines of business, including commercial and all Government Programs and related network management and expansion opportunities.
Job Description
Initiate and lead negotiations for network participation agreements related to all lines of business (commercial and Government Programs), including service area analysis, network development and strategy, and problem resolution.
Participate in the development of provider strategy to support contracting and network development efforts on behalf of Provider Services and Senior Management
Partner closely with leadership from key internal partners from Sales, Underwriting, Medical Economics, Product Development, Compliance, Legal, etc. in developing and implementing provider contracting and network development strategy to support medical cost improvement, market growth, compliance, and legal needs.
Direct Contracting Specialists work by assessing the priority of projects as they relate to the overall provider strategy and corporate goals.
Responsible for management and oversight of Provider Contracting Analytics Team, responsible for the analytic support of contract negotiations, pricing impacts, and network adequacy reporting.
Understanding and ability to communicate various payment methodologies for Hospital, Physician, and ancillary provider reimbursement.
Analyze and report financial impact of reimbursement or methodology changes, directing and evaluating analytics to support provider contracting negotiations.
Supports evaluation and resolution of complex business and technical problems and communicates complex information and developments to appropriate staff.
Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.
Participates in the development, modification and implementation of complex payment methodologies, from fee for service to value-based reimbursements, for various provider types. Makes recommendations and executes on new methodologies that link quality and price to reduce cost trend. Provides expert knowledge around Hospital, Physician, and Medical Home profiles and reimbursement including: ACO’s, bundled episodic payments, capitation, etc
Responsible for operationalizing contracts, including pricing, configuration, communication
Directs workflow by assessing the priority of projects as they relate to the overall provider contract and reimbursement strategy and corporate goals
Handles complex external contract negotiations with all provider types and direct management of vendor relationships and other outside resources associated with all lines of business and Governmental Programs. Acts as main point of contact between the vendor and the internal customer. Develops and implements detailed contract negotiation strategy, including face to face negotiations on multiple types of reimbursement methodologies
Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market
Provides project leadership to facilitate the implementation of new complex applications and complex enhancements of existing applications. Serves as project lead on system enhancements in provider services and network development. Provides oversight to team and technical lead on testing and implementation.
Minimum Qualifications
Bachelor’s degree in business administration, health care administration, computer science, or other relevant academic discipline; or an equivalent combination of education and experience
7 years of experience in healthcare and/or provider services operational processes
3 years of experience in a supervisory or lead capacity
Previous managed care network contracting experience associated with commercial or Government Programs
Fully comfortable understanding, explaining, and using computer processes and applications
Intermediate level keyboard skills
Extensive knowledge of and ability to use Microsoft Windows and Office applications such as Word, Excel, Access, and PowerPoint
Extensive knowledge of managed care processes and contracting
Extensive knowledge of specialized reimbursement methodologies
Skill in negotiating contracts and agreements
Extensive knowledge of FACETS modules, NetworX Pricer and Modeler. Directs workflow by assessing the priority of projects as they relate to the overall provider contract and reimbursement strategy and corporate goals.
Extensive knowledge of financial concepts.
Preferred Qualifications
Master's degree, J.D. or other advanced degree related to health care, finance or business administration
Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.
At Blue Cross and Blue Shield of Kansas City (Blue KC), we have long put our members first by developing products and services to meet their needs. From our founding in 1938 to more than 80 years of experience in innovative, patient-centered healthcare coverage, Blue KC continues to keep our members at the center of everything we do. As a market leader, we continue to embrace new ideas to make healthcare more affordable and to improve the customer experience. Come join us!
Blue Cross and Blue Shield of Kansas City will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully utilize electronic and online job application systems. For assistance, please send an email to Recruitingteam@bluekc.com .
EOE/Veterans/Disability
Affirmative Action Employer
E-Verify Participation (https://bluekcmemberportal.azureedge.net/pdf/2024/E-Verify_Participation_Poster_Eng_Es.pdf)
Equal Employment Opportunity/Nondiscrimination/Affirmative Action Policies
IER Right to Work (https://www.e-verify.gov/sites/default/files/everify/posters/IER_RightToWorkPoster%20Eng_Es.pdf)
FMLA
Employee Polygraph Protection Act (https://www.dol.gov/whd/regs/compliance/posters/eppac.pdf)