Network Manager II

BlueCross BlueShield of Tennessee, Inc.; Chattanooga (TN); Remote; USD 85,000 - 110,000; Full time

Job summary

BlueCross BlueShield of Tennessee, Inc. seeks a Network Manager to strengthen our provider networks across Tennessee.

You will partner with physicians, hospitals, and ancillary providers, assisting with contract negotiations, resolving complex issues, and analyzing reimbursement impacts to improve provider experience and network performance. The ideal candidate has provider contracting/health insurance experience, strong analytical and negotiation skills, and a passion for building productive

Qualifications

• Bachelor's degree or equivalent work experience in business/healthcare.
• 3 years in provider relations and network development with focus on healthcare education and reimbursement.
• Public speaking and effective presentation skills.
• Ability to work independently with minimal supervision and in teams.
• Translate technical concepts into business language for project teams.

Responsibilities

• Identify educational topics and strategies to enhance provider network compliance.
• Support and monitor provider programs and enterprise initiatives.
• Maintain regulatory and contract compliance improvements.
• Handle escalated provider enrollment processing and problem resolution.
• Lead data reporting and analysis to monitor financial and service relations with providers.
• Consult with providers on delivery, training and support issues.
• Travel to provider offices or conduct virtual meetings as required.

Skills

Public speaking

Independent work

Translate complex concepts

MS Office

Analytical skills

Time management

Oral communication

Written communication

Interpersonal skills

Organizational skills

Multi-project handling

Proactive attitude

Real-world healthcare terminology

Contract language knowledge

Education

Bachelor's degree in business or healthcare or relevant field or equivalent work experience

Tools

Microsoft Office

Job description

The Provider Network Management team is seeking a relationship-focused and results-driven Network Manager to support and strengthen our provider networks across Tennessee. In this role, you will serve as a trusted partner to physicians, hospitals, and ancillary providers by assisting with contract negotiations, resolving complex provider issues, analyzing reimbursement impacts, and collaborating with internal teams to improve provider experience and network performance. The ideal candidate brings provider contracting and/or health insurance experience, strong analytical and negotiation skills, and a passion for building productive provider relationships. This position offers the opportunity to make a direct impact on network strategy, provider satisfaction, and operational success while working independently within a highly collaborative team environment.

Job Responsibilities

• Identifying educational topics, methods, and strategies to enhance compliance throughout the provider network.
• Implementing, supporting, and monitoring provider programs and enterprise initiatives
• Implementing processes and changes needed to maintain regulatory compliance, contract compliance or to improve quality.
• Handling escalated provider enrollment processing and problem resolution.
• Leading data reporting and analysis projects to monitor financial and service relations with providers.
• Consulting with providers on delivery, training and support related issues, identifying opportunities for enhancement and recommending solutions.
• Able to travel to provider offices or conduct virtual meetings as required.

Job Qualifications

• Education Bachelors degree in business or healthcare or relevant field or equivalent work experience required
• Experience 3 years - Experience in provider relations and network development with emphasis on healthcare education and reimbursement.
• Skills\Certifications Ability to speak in public and conduct effective presentations.
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Demonstrated ability to interpret and translate technical and/or or complex concepts into information meaningful to project team members and/or business personnel.
• Proficient in Microsoft Office (Outlook, Word, Excel, Access and PowerPoint)
• Accuracy and attention to detail
• Effective time management skills
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Strong analytical skills
• Ability to manage multiple projects and priorities
• Positive attitude, self-driven, engaging, proactive, results drive
• Knowledge in Medical terminology
• Knowledge of contract language and reimbursement methodologies, managed care business processes, case-mix adjustment, medical terminology, utilization management and applications for claims payment, required.
• License Valid Driver's License Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).

Number of Openings Available 1 Worker Type: Employee Company: BCBST BlueCross BlueShield of Tennessee, Inc.

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity.

All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow. At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability. We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST. We foster a culture where innovation is encouraged. That includes using AI enabled tools responsibly to support everyday work — guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve members.

BCBST is a remote-first organization with many employees working primarily from their homes. Each position within the company is classified as either fully remote, partially remote, or office based. BCBST hires employees for remote positions from across the U.S. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense. If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance.