Manager, Provider Network Solutions Operations

Blue Cross and Blue Shield of Kansas•Topeka, KS

32d•Hybrid

About The Position

Under the direction of the Director, Provider Network Solutions Operations, position is responsible for divisional operations activities for the BCBSKS provider networks including enrollment, procedural and record quality initiatives, record maintenance, and provider communications. Designs, implements and monitors procedures to ensure smooth, accurate and timely workflow within the department and works collaboratively across BCBSKS to ensure provider network processes and activities are transparent, and adhere to internal and external audit and compliance requirements. Manage the work of Provider Network Solutions team members ensuring onboarding and network maintenance activities frame a compliant, quality driven provider network to strengthen BCBSKS provider experience and member's access to our provider network. Provide timely education to department team members. Manage department activities in support of meeting corporate goals and objectives. Ensures the accuracy and timeliness of provider data for directory purposes. This position is eligible to work hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas. Why Join Us? Lead and Inspire: Guide and mentor your team to achieve their full potential and success. Family Comes First: Total rewards package that promotes the idea of family first for all employees. Dynamic Work Environment: Collaborate with a team of passionate and driven individuals. Trust: Work for one of the most trusted companies in Kansas Stability: 80 years of commitment, compassion and community

Requirements

Excellent organizational and administrative application skills
Advanced supervisory history demonstrative of coaching success, design of goals and human relations
Excellent Written and Verbal Communications
Broad knowledge of health industry as it relates to professional and institution provider operations
Independent problem solving and analytical skills
Leadership skills focused on strategic review and positioning, problem solving, mediation, and process improvements
Ability to communicate effectively, both orally and in writing
Ability to develop and present educational programs and/or workshops
Ability to direct the development of programs/processes related to compliance with external and accreditation standards and requirements
Strengths in collaboration and foster effective working relationships to build consensus
Budget oversight and adherence
High school diploma or equivalent required. Bachelor's degree with emphasis in general business, communications, or human relations preferred
Minimum of 5 years' experience in health care industry required.
Experience in development and maintenance of provider networks, knowledge of contracting processes, health plan compliance and accreditation standards required.
Three years proven supervisory/management experience required.

Responsibilities

Directs the coordination of activities related to provider contracting and network enrollment. Includes workflow review and assignment, network onboarding activities including contract initiation, record creation and maintenance.
Establishes goals and objectives supporting the management and supervision the daily activities of the department ensuring alignment with corporate goals and objectives.
Collaborates with other departments/divisions to attain accurate and up-to-date information for provider network framework requirements, expectations, adequacy, adherence, and experience.
Responsible for the coordination and general direction of provider network communications to include contracting documents, provider memos, policy updates, network initiatives, etc.
Identifies problems and designs/recommends team member success needs through guidance and coaching.
Ensure compliance of all requirements by law for establishing new provider data, as well as maintenance, and storage.
Identifies, designs, and implements appropriate solutions to staffing, quality and workload problems in a timely and effective manner. Interview, hire, and discipline.
Provides appropriate and timely performance feedback to staff both formally and informally. Reviews and recommends merit and promotion increases.
Anticipates the impact of the changing healthcare environment on assigned work areas and adjusts work assignments and processes as necessary to maintain quality and efficient workflow within the department.
Manages assigned projects meeting deadlines and assuring results meet the business need of the organization.
Responsible for the creation, updates, and publishing of all Provider Network Solutions policies and procedures for both internal transparency and guidance and external accreditation compliance standards.
Direct oversight of Supervisor, Provider Network Enrollment and Supervisor, Provider Network Records and Quality. Indirect supervision of assigned team members to each supervisor.