Manager Provider Relations

Blue Cross and Blue Shield of Kansas•Topeka, KS

About The Position

The Manager of Provider Relations, Provider Network Solutions (PNS) is responsible for overseeing and developing a team of Provider Relations Representatives I’s and/or II’s to ensure effective provider engagement and support across all lines of business. Reporting to the Director of Provider Relations, this role plays a critical part in educating, motivating, and managing relationships with external healthcare providers, contributing to the strategic goals of both the Provider Network Solutions division and the broader Blue Cross Blue Shield of Kansas (BCBSKS) organization. Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas. Why Join Us? Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans. 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. Compensation $135,440 - $169,300 Exempt grade 19 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The salary range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive salaries that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Requirements

High school diploma or GED required.
Bachelor’s degree in business administration, Healthcare Management, or related field preferred.
Minimum of 6 years of experience in healthcare provider network management and operations.
At least 3 years of supervisory experience is required.
Direct, face-to-face experience with healthcare providers is strongly preferred.
Proven communication skills, with the ability to clearly articulate complex ideas and implement strategies to diverse audiences.
Strong relationship building and managing experience.
High degree of human relations skills with the ability to speak and communicate effectively.
Knowledge of healthcare regulations, provider contracting, and market dynamics.
Understanding of business operations, financial management, and performance metrics in a healthcare context.
Understanding of healthcare regulations, provider contracting, and industry standards.
Requires extensive travel across the state including overnight stays to attend and conduct provider meetings. Travel can encompass up to two nights per week.
Requires valid Kansas driver’s license.
Must be able to maintain confidentiality.
Regular and predictable attendance is an essential job function as defined by policy.
Must comply with implementing corporate information security policies, standards, and guidelines relative to access control.
Must follow URAC standards as required for essential job functions.
Proven analytical and critical thinking skills with implementation skills where goals and the strategy are identified.
Must have the capability of understanding, embracing and demonstrating the company’s core competencies and values of integrity, dependability, service, growth and progress, and courage.

Responsibilities

Lead, mentor, and coach a team of Provider Relations Representatives to achieve department objectives.
Foster an environment of collaboration, growth, and continuous improvement.
Serve as a point of escalation for complex issues that may arise with providers, offering solutions and facilitating timely resolutions.
Ensure clear and open communication between the provider network and internal stakeholders.
Develop and maintain BCBSKS network of in-network providers for all lines of business.
Develop and track key performance indicators (KPIs) to measure the effectiveness and productivity of the team.
Continuously identifying areas for improvement and implement strategies to enhance team performance and provider satisfaction.
Instructs provider relations representative in communication and contract work necessary for orientation/education for in-network providers for all lines of business currently contracted for.
Contribute to the long-term growth and direction of the Provider Network Solutions division, working on projects and initiatives that improve network quality, provider experience, and overall operational efficiency.
Field activity priorities related to provider education, conflict resolution, contracting and credentialing.
Selects, trains and develops provider relations staff.
Evaluates their potential and improves their performance through counseling, training, delegation, and mutual planning of their activities.
Coordination and general direction of written communications and educational materials to assure accurate claims coding by providers.
In collaboration with the other Provider Relations Managers and the Manager of Training and Education, develop innovative methods and materials such as brochures, audio-visual presentations, posters, manuals and guides to make educational programs and recruitment of in-network providers more effective.
In collaboration with the other Provider Relations Managers and the Manager of Training and Education, implement and participate in training programs to improve the effectiveness of field staff.
In collaboration with the other Provider Relations Mangers and the Director of Provider Relations, discusses medical, financial and administrative policy matters as they impact the provider network.
With the collaboration of the other Provider Relations Managers and PNS Operations, provides direct input into the development of policies and procedures for the implementation of provider contracts and needed policy memo changes that needed to be completed and communicated. Including annual mailings of reimbursement and incentive program changes.
Assists with field utilization review activities by directing field representative contacts and/or personal provider contacts when applicable.
In collaboration with the Manager of Credentialing, conducts the credentialing office site assessment visitation program (as applicable), and obtaining delinquent credentialing materials and other activities related to participation as assigned.
As directed, interacts cross-divisionally with all levels of management and represents provider relations on corporate issues requiring committee assembly and action.
Participates in assigned liaison meetings as needed.
Overseeing potential provider negotiations impacting provider reimbursement rates with administration when establishing provider networks or specialty contracting in Kansas and counties contiguous to the state. Additionally ensures an effective working relationship is established and maintained with the providers within approved budget limits.
Organizes and plans special projects as directed by the director of provider relations.
Evaluating staff workload and potential expansion opportunities and make recommendations to the Director, provider relations concerning the hiring of needed personnel.
Directly responsible for hiring activities.
Regularly attends and represents BCBSKS in external community events and programs.
Must be accessible via text, voice and/or email, and be available to respond timely during non-working hours as scheduled and needed.

Benefits

Base compensation is only one component of your competitive Total Rewards package
Incentive pay program (EPIP)
Health/Vision/Dental insurance
6 weeks paid parental leave for new mothers and fathers
Fertility/Adoption assistance
2 weeks paid caregiver leave
5% 401(k) plan matching
Tuition reimbursement
Health & fitness benefits, discounts and resources

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