Network Manager II

BlueCross BlueShield of Tennessee; United States; On-site; USD 90,000 - 120,000; Full time

Job summary

BlueCross BlueShield of Tennessee is seeking a Network Manager to strengthen our provider networks across Tennessee. You will partner with physicians, hospitals, and ancillary providers to assist with contract negotiations, resolve complex issues, analyze reimbursement impacts, and collaborate with internal teams to improve provider experience and network performance.

The ideal candidate has provider contracting/health insurance experience, strong analytical and negotiation skills, and a passion

Qualifications

• Bachelor's degree or equivalent experience required.
• 3 years - provider relations and network development experience.

Responsibilities

• Identify educational topics and strategies to enhance compliance in the provider network.
• Support and monitor provider programs and enterprise initiatives.
• Maintain regulatory and contract compliance and drive quality improvements.
• Process and resolve escalated provider enrollment issues.
• Lead data reporting and analysis to monitor financial and service relationships.
• Consult with providers on delivery, training and support issues and offer improvements.
• Travel to provider offices or conduct virtual meetings as needed.

Skills

Public speaking

Independent work

Analytical skills

Communication skills

Microsoft Office

Medical terminology

Contract language

Reimbursement methods

Provider relations

Utilization management

Education

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

Tools

Office software

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). *The definition for \"routine basis\" is defined as daily, weekly or at regularly schedule times.

Number of Openings Available

1

Worker Type

Employee

Company

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

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.