BlueCross BlueShield of South Carolina
Manager, Provider Contract
BlueCross BlueShield of South Carolina, Columbia, South Carolina, United States, 29204
Provider Network Manager
Establishes and maintains provider networks for assigned lines of business. Serves as main contact for all recruiting or recontracting efforts and all contract questions or issues that arise with providers. Recommends and implements cost-effective strategies while delivering high quality products to customers. This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 4101 Percival Rd. Columbia, SC, 29229. Develops and manages relationship with providers. Conducts initial/renewal contract negotiations with providers. Performs detailed financial analysis and modeling of provider contract proposals to determine financial impact of various pricing/contract decisions. Influence provider behavior by means of education, utilization analysis and presentation of provider performance. Ensures contract obligations are met. Directs/coordinates credentialing process for provider networks. Monitors performance to ensure contract compliance by internal departments and medical providers. Reviews/audits data compiled by subcontractors in accordance with the Center for Medicare and Medicaid services (CMS) regulations. Assists with impact analysis of pricing decisions regarding negotiated payment rates for network providers. Develops/maintains effective working relationships with providers, government agencies, internal departments, and other customers. Ensures responses are given in a timely manner to all inquiries. Maintains working knowledge of current and proposed regulations of state and federal laws and the latest trends in healthcare technology and financing. Evaluates and communicates any pertinent changes to management. Assists in the development of training programs and materials for internal staff. Participates in special projects to improve external and internal processes. Required Education: Bachelor's Degree Required Work Experience: 5 years of relevant financial/administrative experience in an insurance, managed care or healthcare related setting that may include provider relations, managed care contracting, provider operations, provider billing, etc. Required Skills and Abilities: Ability to develop/maintain effective business relationships with providers, and representatives. Excellent verbal and written communication skills. Excellent presentation and project management skills. Excellent analytical and critical thinking skills. Ability to handle confidential or sensitive information with discretion. Demonstrated knowledge of managed care contract negotiations. Required Software and Other Tools: Microsoft Office. Working knowledge of reimbursement systems. We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
Establishes and maintains provider networks for assigned lines of business. Serves as main contact for all recruiting or recontracting efforts and all contract questions or issues that arise with providers. Recommends and implements cost-effective strategies while delivering high quality products to customers. This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 4101 Percival Rd. Columbia, SC, 29229. Develops and manages relationship with providers. Conducts initial/renewal contract negotiations with providers. Performs detailed financial analysis and modeling of provider contract proposals to determine financial impact of various pricing/contract decisions. Influence provider behavior by means of education, utilization analysis and presentation of provider performance. Ensures contract obligations are met. Directs/coordinates credentialing process for provider networks. Monitors performance to ensure contract compliance by internal departments and medical providers. Reviews/audits data compiled by subcontractors in accordance with the Center for Medicare and Medicaid services (CMS) regulations. Assists with impact analysis of pricing decisions regarding negotiated payment rates for network providers. Develops/maintains effective working relationships with providers, government agencies, internal departments, and other customers. Ensures responses are given in a timely manner to all inquiries. Maintains working knowledge of current and proposed regulations of state and federal laws and the latest trends in healthcare technology and financing. Evaluates and communicates any pertinent changes to management. Assists in the development of training programs and materials for internal staff. Participates in special projects to improve external and internal processes. Required Education: Bachelor's Degree Required Work Experience: 5 years of relevant financial/administrative experience in an insurance, managed care or healthcare related setting that may include provider relations, managed care contracting, provider operations, provider billing, etc. Required Skills and Abilities: Ability to develop/maintain effective business relationships with providers, and representatives. Excellent verbal and written communication skills. Excellent presentation and project management skills. Excellent analytical and critical thinking skills. Ability to handle confidential or sensitive information with discretion. Demonstrated knowledge of managed care contract negotiations. Required Software and Other Tools: Microsoft Office. Working knowledge of reimbursement systems. We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.