Network Manager II

BlueCross BlueShield of Tennessee • Knoxville, TN

115d • Remote

About The Position

Are you located in Knoxville, Tennessee and have experience working directly with providers? If so, you may be a perfect fit for an opening on our Provider Networks & Contracting team, focusing on the Knoxville market! We are looking for an energetic, detail-oriented individual to become part of this team as a Network Manager. As a Network Manager, you will serve as the primary liaison and first point of contact for designated providers in Knoxville. Your role involves educating and assisting market providers, maintaining relationships through daily interactions, and providing technical support to correct errors and manage risks for both the insurer and provider. Strong interpersonal skills are essential for effective partnership and collaboration. You will work closely with network contracting and other BCBST matrix partners, such as enrollment and operations, to support providers and achieve market initiatives. Key skills for this role include collaboration, problem-solving, and organization. The hiring team is looking for an individual with the following experience: 3 years of experience in provider relations and network development with emphasis on healthcare education and reimbursement Claim adjudication experience related to facility and professional providers Established relationships with providers in the Knoxville market Strong interpersonal skills, as building strong partnerships is key to the success in this role FACETS knowledge is preferred but not required This is a remote position with occasional provider and team meetings in Knoxville, TN and surrounding counties.

Requirements

• Bachelors degree in business or healthcare or relevant field or equivalent work experience required
• 3 years - Experience in provider relations and network development with emphasis on healthcare education and reimbursement.
• Ability to speak in public and conduct effective presentations.
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Demonstrated ability to interpret and translate technical and/or or complex concepts into information meaningful to project team members and/or business personnel.
• Proficient in Microsoft Office (Outlook, Word, Excel, Access and PowerPoint)
• Accuracy and attention to detail
• Effective time management skills
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Strong analytical skills
• Ability to manage multiple projects and priorities
• Positive attitude, self-driven, engaging, proactive, results drive
• Knowledge in Medical terminology
• Knowledge of contract language and reimbursement methodologies, managed care business processes, case-mix adjustment, medical terminology, utilization management and applications for claims payment, required.
• Valid Driver's License
• Employees who are required to operate either a personal or rental vehicle for company business on a routine basis will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.

Nice To Haves

• Claim adjudication experience related to facility and professional providers
• Established relationships with providers in the Knoxville market
• Strong interpersonal skills, as building strong partnerships is key to the success in this role
• FACETS knowledge is preferred but not required

Responsibilities

• Identifying educational topics, methods, and strategies to enhance compliance throughout the provider network.
• Implementing, supporting, and monitoring provider programs and enterprise initiatives
• Implementing processes and changes needed to maintain regulatory compliance, contract compliance or to improve quality.
• Handling escalated provider enrollment processing and problem resolution.
• Leading data reporting and analysis projects to monitor financial and service relations with providers.
• Consulting with providers on delivery, training and support related issues, identifying opportunities for enhancement and recommending solutions.
• Able to travel to provider offices or conduct virtual meetings as required.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees