Our commitment is to improve the cost, quality, and access of healthcare for our customers by applying industry experience to reimagine and reshape the future of healthcare. Our Network Development Contractors negotiate contract terms and establish contractual relations with providers.
Important to Know
- Local position in South Florida
- This role will require some travel to provider locations for meetings and to maintain client relationships
- Must reside in the South Florida Region
Scope
- Coordinate the implementation of contractual arrangements with internal business partners
- Implement corrective action to enhance network performance and monitor results
- Establish and maintain positive relationship for assigned providers
- Issue resolution
- External execution of operational initiatives: self- service tools, retail, projects
- Implement medical cost management initiatives
- Proactively communicates and trains provider on administrative policies, business processes, capabilities and initiatives
- Perform site visits to address member complaints/potential quality issues
- Support professional organization relationship events
- Execute provider facing deliverables for key projects
Required Experience
- 5+ years related work experience or equivalent combination of transferable experience and education in developing and maintaining provider contracts and/or relationships
- Related Bachelor’s degree or additional related equivalent work experience
- Experience of provider payment programs and billing practices
- Experience of insurance products and network configurations
- Excellent verbal and written communication skills
- Experience in issue resolution with ancillary and hospital based providers
- Experience interpreting analytical data
- Valid Driver License Frequent local travel with occasional overnight stays
Preferred Qualifications
- Experience using BCBSF systems (Diamond, Provider Information Platform (PIP), Siebel)
- 3 or more years of experience negotiating standard and non-standard provider contracts
- Experience negotiating with third-party representatives, hospital-based provider organizations and or ancillary provider organizations
- Experience using the Network Management Simulation Tool (SIM) Medicare and Medicaid experience
- Experience of provider payment programs and billing practices
- Experience in issue resolution with ancillary and hospital based providers
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.
Physical Enviroment
- Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences).
- Exerting up to 10 pounds of force occasionally to move objects
- Jobs are sedentary if traversing activities are required only occasionally