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Director, Provider Network Development
at Jennifer Bunting in Providence, RI
Your Health Matters, That’s Why We Are Here!
Position Description
Blue Cross Blue Shield of Rhode Island has an exciting opportunity for individuals with strong skills developing and negotiating strategies with BCBSRI’s most complex and strategic provider partners.
We are currently seeking a Director, Network Management for our Providence, Rhode Island office. As a Director, Network Management, the successful candidate will be responsible for negotiating strategies with key physician practices, hospitals, other health care providers, and vendors. This person will also work to achieve the organization’s financial and business objectives, impacting network quality and trends via thoughtfully structured contractual relationships with providers and vendors.
Position Responsibilities
•Deliver a broad, stable and high-performing network to customers.
•Develop and execute negotiation strategies that directly impact financial and quality performance of the network consistent with Leadership objectives; leveraging deep financial views into and understanding of quality and trend performance.
•Accountable for all network development and management activities with hospitals, and/or physicians.
•Ensure provider agreements comply with BCBSRI policies, business standards and regulatory guidelines.
•Build and maintain strong, respectful professional relationships with provider Leadership.
•Perform and monitor activities related to the contract load process; engage appropriate service organization for claims resolution; provider service/performance issues; and provider appeals.
•Proactively provide guidance/recommendations to organizational Leadership regarding health care costs and benchmarks, trend impact opportunities as well as provider quality opportunities.
•Always maintain highest personal/professional integrity and enforce BCBSRI Principles of Integrity and Compliance.
•Coaches, mentors and assists other Network Managers.
Position Requirements
•Bachelors degree in business, health care management, or related field required or an equivalent combination of education and work experience.
•Six to ten years in a network development/contract management role, negotiating healthcare contracts with providers.
Preferred Education, Additional Qualifications and Experience
•Masters degree in business or health administration preferred.
Position Skills and Abilities
•Demonstrated success in negotiating agreements with complex providers/strategic partners; including constructing and successfully negotiating complex hospital and physician agreements. Containing integrated provider financial/incentive concepts.
•Strong negotiation skills.
•Successful track record of leading processes, individuals and teams.
•Deep understanding of provider delivery models, provider financing as well as health plan operations and financing.
•High degree of proficiency in developing, interpreting and utilizing provider financial and quality data; can effectively distill large and complex volumes of information into clear and critically processed recommendations, strategies and tactics.
•Strong knowledge of provider reimbursement methodologies, including, but not limited to RBRVS, Ambulatory Surgery Center groupers, per diem, per case, DRGs and APCs.
•Solid understanding of provider billing/claims processing practices, coding standards as well as industry standard payment and medical policies.
•Independent and creative professional with superior critical processing capabilities.
•Organized and able to simultaneously handle multiple complex priorities.
•Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner.
•Collaborator; ability to establish strong rapport and work well with others.
•Propensity to look outward consistently to understand best in class and competitive network performance positions and utilize the knowledge to formulate impactful strategies.
•Capable of mentoring and professional development needs of existing Network Managers
To be a part of this exceptional organization, APPLY TODAY!
http://hire.jobvite.com/j/?aj=o1akVfwa&s=4insurancejobs.com
Benefits That Make a Difference!
Blue Cross & Blue Shield of Rhode Island (BCBSRI) offers one of the most comprehensive benefit packages available, including:
•Competitive compensation package
•Family medical and dental benefits at little or no cost to employees
•401k plan
•Company-paid retirement benefit
•Paid holidays, generous paid time off
•Tuition assistance program
•Worksite wellness programs
•Child care and elder care referrals
If you would like to be a part of Blue Cross and Blue Shield of Rhode Island and its commitment to Rhode Island, please apply today! An Equal Opportunity Employer
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, gender identity or expression
Position Description
Blue Cross Blue Shield of Rhode Island has an exciting opportunity for individuals with strong skills developing and negotiating strategies with BCBSRI’s most complex and strategic provider partners.
We are currently seeking a Director, Network Management for our Providence, Rhode Island office. As a Director, Network Management, the successful candidate will be responsible for negotiating strategies with key physician practices, hospitals, other health care providers, and vendors. This person will also work to achieve the organization’s financial and business objectives, impacting network quality and trends via thoughtfully structured contractual relationships with providers and vendors.
Position Responsibilities
•Deliver a broad, stable and high-performing network to customers.
•Develop and execute negotiation strategies that directly impact financial and quality performance of the network consistent with Leadership objectives; leveraging deep financial views into and understanding of quality and trend performance.
•Accountable for all network development and management activities with hospitals, and/or physicians.
•Ensure provider agreements comply with BCBSRI policies, business standards and regulatory guidelines.
•Build and maintain strong, respectful professional relationships with provider Leadership.
•Perform and monitor activities related to the contract load process; engage appropriate service organization for claims resolution; provider service/performance issues; and provider appeals.
•Proactively provide guidance/recommendations to organizational Leadership regarding health care costs and benchmarks, trend impact opportunities as well as provider quality opportunities.
•Always maintain highest personal/professional integrity and enforce BCBSRI Principles of Integrity and Compliance.
•Coaches, mentors and assists other Network Managers.
Position Requirements
•Bachelors degree in business, health care management, or related field required or an equivalent combination of education and work experience.
•Six to ten years in a network development/contract management role, negotiating healthcare contracts with providers.
Preferred Education, Additional Qualifications and Experience
•Masters degree in business or health administration preferred.
Position Skills and Abilities
•Demonstrated success in negotiating agreements with complex providers/strategic partners; including constructing and successfully negotiating complex hospital and physician agreements. Containing integrated provider financial/incentive concepts.
•Strong negotiation skills.
•Successful track record of leading processes, individuals and teams.
•Deep understanding of provider delivery models, provider financing as well as health plan operations and financing.
•High degree of proficiency in developing, interpreting and utilizing provider financial and quality data; can effectively distill large and complex volumes of information into clear and critically processed recommendations, strategies and tactics.
•Strong knowledge of provider reimbursement methodologies, including, but not limited to RBRVS, Ambulatory Surgery Center groupers, per diem, per case, DRGs and APCs.
•Solid understanding of provider billing/claims processing practices, coding standards as well as industry standard payment and medical policies.
•Independent and creative professional with superior critical processing capabilities.
•Organized and able to simultaneously handle multiple complex priorities.
•Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner.
•Collaborator; ability to establish strong rapport and work well with others.
•Propensity to look outward consistently to understand best in class and competitive network performance positions and utilize the knowledge to formulate impactful strategies.
•Capable of mentoring and professional development needs of existing Network Managers
To be a part of this exceptional organization, APPLY TODAY!
http://hire.jobvite.com/j/?aj=o1akVfwa&s=4insurancejobs.com
Benefits That Make a Difference!
Blue Cross & Blue Shield of Rhode Island (BCBSRI) offers one of the most comprehensive benefit packages available, including:
•Competitive compensation package
•Family medical and dental benefits at little or no cost to employees
•401k plan
•Company-paid retirement benefit
•Paid holidays, generous paid time off
•Tuition assistance program
•Worksite wellness programs
•Child care and elder care referrals
If you would like to be a part of Blue Cross and Blue Shield of Rhode Island and its commitment to Rhode Island, please apply today! An Equal Opportunity Employer
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, gender identity or expression
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