Manager, Provider Network Solutions Operations
About the position
The position is responsible for overseeing divisional operations activities for the BCBSKS provider networks, focusing on enrollment, procedural quality initiatives, record maintenance, and provider communications. The role involves designing, implementing, and monitoring procedures to ensure efficient workflow and compliance with audit requirements. The individual will manage the Provider Network Solutions team, ensuring quality-driven network maintenance and enhancing the provider experience for members. This position also includes providing education to team members and aligning departmental activities with corporate goals.
Responsibilities
Direct the coordination of activities related to provider contracting and network enrollment.
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Establish goals and objectives for managing daily departmental activities.
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Collaborate with other departments to ensure accurate provider network information.
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Coordinate provider network communications, including contracting documents and policy updates.
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Identify problems and recommend solutions for team member success.
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Ensure compliance with legal requirements for provider data management.
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Design and implement solutions for staffing, quality, and workload issues.
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Conduct interviews, hiring, and disciplinary actions for team members.
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Provide performance feedback and recommend merit increases.
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Adjust work assignments based on changes in the healthcare environment.
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Manage projects to meet deadlines and business needs.
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Create and update Provider Network Solutions policies and procedures.
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Oversee the Supervisor of Provider Network Enrollment and Supervisor of Provider Network Records and Quality.
Requirements
High School diploma or equivalent required.
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Bachelor's degree in general business, communications, or human relations preferred.
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Minimum of 5 years' experience in the healthcare industry required.
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Experience in development and maintenance of provider networks and knowledge of contracting processes required.
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Three years of proven supervisory/management experience required.
Nice-to-haves
Broad knowledge of the health industry as it relates to provider network operations.
Benefits
Incentive pay program (EPIP)
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Health/Vision/Dental insurance
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6 weeks paid parental leave for new mothers and fathers
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Fertility/Adoption assistance
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2 weeks paid caregiver leave
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5% 401(k) plan matching
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Tuition reimbursement
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Health & fitness benefits, discounts and resources
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