Provider Contracting Manager

Blue Cross and Blue Shield of Nebraska

1d•Hybrid

About The Position

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. Candidates applying to this position may be hybrid or remote and can live in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas. This position is responsible for physician, hospital, and ancillary provider contracting for BCBSNE Commercial and Medicare Advantage Network. This job requires pursuit of executed contracts with health care providers and participation in the strategic administration of the provider networks and related reimbursement of participating providers. You will be responsible for negotiating all language and payment terms with providers for both commercial and Medicare business. This position is responsible for negotiating and executing case specific out-of-network exceptions for BCBSNE members who utilize providers, who are not participating in a Blue Cross Blue Shield provider network. This person works with the Legal Department in resolving contractual questions and issues posed by participating network providers.

Requirements

Bachelor’s degree in Business, Health Care, or a related field
Three (3) years of provider contracting and/or provider network administration experience.
An equivalent combination of education and experience may be substituted for this requirement.
The ability to meet or exceed the attendance and timeliness requirements of their departments.
The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed are representative of the knowledge, skill, and or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Other duties may be assigned.

Nice To Haves

Familiarity with Medicare Advantage

Responsibilities

Contact and negotiate out-of-network exceptions with out-of-networkproviders and hospitals utilized by BCBSNE members.
Will work heavily with both BCBSNE and external legal departments to properly outline and negotiate contract language.
Create, implement, and edit provider contracts templates, including negotiating language and payment terms.
Ensure sustainability and growth of the Commercial Business and Medicare Advantage Network through provider relationships, new contractual agreements, and supporting provider questions.
Negotiate with providers to enhance availability of health care services for BCBSNE Commercial and Medicare Advantage programs.
Memorialize results of provider negotiations in provider agreements, addendums, and attachments.
Assist department leadership in strategic planning and resolving issues during key provider negotiations.
Collaborate with cross functional teams to ensure consistency and strategy in practice.
Participate in determining methodologies used to reimburse network providers.
Review and respond to requests for Open Negotiation on surprise billings.