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Please note that effective Jan. 4, 2022, Blue Cross and Blue Shield of Louisiana will require all employees to be fully vaccinated for COVID?19, unless legally entitled to a reasonable accommodation related to religious or medical exemptions.
POSITION PURPOSEServes as the Plan representative responsible for negotiating competitive provider reimbursement and terms within all contracts to result in improving the cost competitive position of BCBSLA in the marketplace. Serves as the Plan representative responsible for establishing and maintaining favorable relationships with providers. The position focuses upon provider contracting with incumbents dedicating at least 65% of their time to achieving contract negotiation goals.
Makes recommendations to management as it relates to network development, network strategies for implementation and maintenance of contracts, policies, and procedures. Must demonstrate thorough understanding of all provider network requirements, including but not limited to credentialing and accreditation, network participation, complex reimbursement methodologies, contract performance measures, Plan quality initiatives, BCBSA initiatives, and corporate initiatives. Researches and resolves most provider issues related to their contracts and demonstrates ability to work independently and problem solve with minimal direction needed.
NATURE AND SCOPE- This role does not manage people
- This role reports to this job: Manager, Provider Contracting
- Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with:
Provider personnel at all levels including CEO, CFO and legal counsel and their related associations and agents, all staff of the Network Administration Division, all Plan personnel with specific interaction required for key personnel within each division, Blue Cross and Blue Shield Association (BCBSA) personnel, Plan personnel from all other BCBS Plans, and leaders of the various health care organizations.
QUALIFICATIONS
Education- Bachelor's degree in business, health care or a related field is required.
- Four years of related experience can be used in lieu of a Bachelor’s degree.
Work Experience- 3 years of experience in the health care industry focusing on the establishment and maintenance of hospital and facility managed care contractual agreements, face-to-face interaction and business relationships with providers in a managed care setting and managed care hospital and facility contracting experience is required. Prefer up to 4 years of experience.
- Managed care contracting experience with other provider types is preferred.
Skills and Abilities- Excellent written and oral communication skills, including well-defined and proven public speaking skills are required.
- Excellent interpersonal skills and proven complex negotiating skills to address and handle all provider contacts, proven hospital/facility contract negotiations and problem resolution with tact and diplomacy are required.
- Must have ability to prioritize and handle multiple competing responsibilities with successful outcomes.
- Must have proven problem solving skills and ability to independently analyze and dissect provider contracts, relationships and issues and create workable win-win solutions for both the provider and BCBSLA.
- Must have proficient skills using PC based applications to develop and report on provider activity using Microsoft Word, Excel, PowerPoint and Outlook. Firsthand knowledge and experience with the Emptoris Contract Management System is preferred.
- Must have ability to respond quickly to requests for provider on-site visits.
- Must have dependable transportation and be willing to travel frequently throughout the state as necessary.
- Must maintain professionalism at all times and represent BCBSLA in an appropriate manner.
Licenses and CertificationsACCOUNTABILITIES AND ESSENTIAL FUNCTIONS- Builds effective provider networks by independently negotiating contractual language and competitive reimbursement with all provider types that pose a mid to high level degree of difficulty to ensure consistency with corporate goals and budget.
- Acts as a professional resource to answer all contractual questions posed by providers and/or internal departments within the organization, including but not limited to, assisting providers with difficult problems unable to be resolved through normal/available channels, participating in dispute resolution process for providers in assigned territory according to Network Policy and Procedure, participating as appropriate for in-services and workshops, and call on network providers on a regular basis or as needed, to help ensure provider contract compliance and provider satisfaction.
- Provides clear, concise and timely reporting to management and/or other plan personnel regarding the progress of provider network development including monitoring and reporting significant developments and changes to key administrative provider contacts occurring within the provider community to management to ensure the company is appropriately advised and strategically aligned on network issues.
- Acts as point of contact for providers by monitoring and overseeing the implementation of providers in the network as well as the provision of the materials and paperwork necessary to participate in networks to ensure efficiencies, provider satisfaction and goals of the department for timely set up are met.
- Maintains current information on all aspects of assigned market including our plan’s competitive position within the market and working within the organization to insure adequate and appropriate provider access for our members.
- Works in conjunction with all internal departments to help maintain the Blue Cross market share.
- Engages providers in participation of applicable corporate initiatives to ensure appropriate audiences are informed accurately and timely.
- Maintains current knowledge of URAC accreditation requirements for Network to help obtain or exceed departmental, divisional and/or company goals.
- Accountable for complying with all laws and regulations associated with duties and responsibilities.
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions- Perform other job-related duties as assigned, within your scope of responsibilities.
- Job duties are performed in a normal and clean office environment with normal noise levels.
- Work is predominately done while standing or sitting.
- The ability to comprehend, document, calculate, visualize, and analyze are required.
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An Equal Opportunity Employer
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