Manager, Provider Contract

Logistics: BlueCross BlueShield of South Carolina - About Us | BlueCross BlueShield of South Carolina

Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 4101 Percival Rd. Columbia, SC, 29229.

What You'll Do:

• Develops and manages relationship with providers. Conducts initial/renewal contract negotiations with providers. Performs detailed financial analysis and modeling of provider contract proposals to determine financial impact of various pricing/contract decisions. Influence provider behavior by means of education, utilization analysis and presentation of provider performance. Ensures contract obligations are met. Directs/coordinates credentialing process for provider networks.
• Monitors performance to ensure contract compliance by internal departments and medical providers. Reviews/audits data compiled by subcontractors in accordance with the Center for Medicare and Medicaid services (CMS) regulations. Assists with impact analysis of pricing decisions regarding negotiated payment rates for network providers.
• Develops/maintains effective working relationships with providers, government agencies, internal departments, and other customers. Ensures responses are given in a timely manner to all inquiries.
• Maintains working knowledge of current and proposed regulations of state and federal laws and the latest trends in healthcare technology and financing. Evaluates and communicates any pertinent changes to management.
• Assists in the development of training programs and materials for internal staff. Participates in special projects to improve external and internal processes.

To Qualify for This Position, You'll Need the Following:

• Required Education: Bachelor's Degree
• Required Work Experience: 5 years of relevant financial/administrative experience in an insurance, managed care or healthcare related setting that may include provider relations, managed care contracting, provider operations, provider billing, etc.
• Required Skills and Abilities: Ability to develop/maintain effective business relationships with providers, and representatives. Excellent verbal and written communication skills. Excellent presentation and project management skills. Excellent analytical and critical thinking skills. Ability to handle confidential or sensitive information with discretion. Demonstrated knowledge of managed care contract negotiations.
• Required Software and Other Tools: Microsoft Office. Working knowledge of reimbursement systems.

We Prefer That You Have the Following:

• Preferred Education: Bachelor's degree-in Healthcare Administration, Business Administration, Nursing, or other job related field.
• Preferred Work Experience: 8 years of relevant financial experience in a healthcare setting that may include provider relations, provider contracting, provider operations, or provider billing, etc. Extensive experience in value-based contracting. 5 years of Medicaid-related experience. Proven ability to conduct comprehensive financial analysis and develop detailed models for provider contract proposals.
• Preferred Skills and Abilities: General knowledge of provider billing/accounting systems including electronic claims filing.

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.comor call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

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