HealthRules Medicare Provider Sr Manager

Accenture•Kirkland, WA

22h

About The Position

Accenture is a global professional services company with leading capabilities in digital, cloud, and security, offering Strategy and Consulting, Interactive, Technology, and Operations services. The company serves clients in more than 120 countries. This role is for a senior delivery leader with deep expertise in Medicare provider networks, Blue Cross Blue Shield (BCBS) implementations, and HealthEdge HealthRules Payor. The successful candidate will have hands-on experience designing and implementing provider networks that support BlueCard® participation, inter-plan arrangements, and complex Medicare contracting models. As a Senior Manager, this individual will own provider network strategy and execution across large-scale BCBS and Medicare implementations, serving as a trusted advisor to clients and leading high-impact delivery teams within Accenture Health & Public Service Technology.

Requirements

Minimum of 5 years of functional business experience in the health payer industry, with deep expertise in - Medicare, Provider, or BCBS operating Models.
Minimum of 3 years of experience implementing provider networks for Blue Cross Blue Shield plans, including support for BlueCard® participation
Minimum of 3 years of hands-on experience implementing or supporting HealthEdge HealthRules Payor, including HealthRules Designer
Experience leading full life-cycle implementations aligned to the Software Development Life Cycle (SDLC)
Bachelor's degree or equivalent (minimum 12 years' work experience). If Associate’s Degree, must have equivalent minimum 6-year work experience

Responsibilities

Provide end-to-end leadership for Medicare provider and supplier network implementation within HealthRules Payor, including BCBS-affiliated plans
Lead design efforts supporting BlueCard® provider networks, ensuring accurate cross-plan participation and claims readiness
Own provider network strategy and setup, including: Suppliers (TINs), practitioners, practitioner roles, and supplier locations
Provider networks aligned to BCBS and BlueCard participation rules
Medicare provider contracts, reimbursement structures, and fee schedules
Translate BCBS, BlueCard, and Medicare regulatory requirements into scalable HealthRules configuration solutions
Ensure HealthRules business rules integrate seamlessly with enterprise claims, billing, and downstream operational systems
Advise configuration, testing strategy, and documentation for HealthRules Payor and Designer components
Partner with Functional, Integration, Data, and Testing leads to ensure cohesive, end-to-end delivery across complex workstreams
Serve as a primary client adviser for BCBS provider network and BlueCard-related topics, guiding decision-making and issue resolution
Proactively identify and mitigate risks related to provider network setup, BlueCard compliance, and Medicare claims impacts
Contribute to practice growth, delivery assets, and capability development within Accenture’s Medicare and payer technology practice