Provider Network Executive III

Premera Blue Cross•Mountlake Terrace, WA

2d•Hybrid

About The Position

The Provider Network Executive III (PNE III) develops and maintains effective relationships with a variety of Premera’s key custom provider accounts to achieve Premera’s operational and strategic goals, product development strategies, and continuity of Premera’s vision and values. In this highly visible role, the PNE III is responsible for the negotiation and management of Premera’s strategic provider relationships across the state of Washington. Success in this position is essential to support Premera’s broader strategy, including the successful implementation of new products through effective provider engagement and negotiation to ensure alignment, support and adoption.

Requirements

Bachelor’s degree or four (4) years of experience in a provider or payer environment.
Four (4) years of experience in payer or provider contracting and managing provider relationships in health care or insurance industry to include: Two (2) years of experience negotiating contracts.
Working knowledge of Health Insurance Portability and Accountability Act (HIPAA), the National Committee for Quality Assurance (NCQA), government health care programs, and risk coding.
Knowledge of network development and provider/vendor network recruitment.
Knowledge of provider community and market anomalies.
Demonstrated ability to effectively manage complex contract negotiations.
Demonstrated ability to develop and execute strategy.
Strong experience and expertise in Provider Relations.
Independent work style, self-motivated, with ability to lead with minimal direction.
Demonstrated successful verbal and written communication skills including ability to develop and deliver public presentations, training, meeting facilitation, and broker presentations.
Strong analytical skills and problem-solving skills.
Proven ability to lead and direct teams addressing complex issues.
Strong interpersonal skills coupled with the ability to foster positive working relationships.
Strong organizational, planning and administrative skills.
Ability to work under pressure with tight timelines, limited resources, competing priorities and manage to specific project timelines.

Nice To Haves

Master’s degree in a related field.
Project management experience.
Hospital contract negotiation experience.

Responsibilities

Develop and execute ongoing account management and service strategy to meet corporate strategic / financial objectives.
Serve as main point of contact for the provider and coordinate all Premera interactions with assigned provider accounts.
Build and maintain positive physician/provider relationships, generally with more complex accounts.
Utilize consultative skills, industry knowledge, and Premera product knowledge to foster a collaborative approach to quality care, network stability and cost containment.
Monitor and analyze network performance.
Develop and maintain effective provider networks (standard and custom), often with complex payment methodologies.
Participate in payment and delivery systems innovation initiatives.
Lead negotiation and implementation of complex or custom provider contracts.
Complete negotiations within preplanned rate targets, meet timelines, ensure the established implementation period and perform implementation audits for accuracy of assigned accounts.
Collaborate with Healthcare Economics in rate development and proposal analysis.
Establish and lead a multi-disciplinary team to provide operationally excellent service and support to assigned accounts.
Consult and educate assigned accounts and internal stakeholders, providing industry and cross account expertise.
Create provider specific and public presentations.
Proactively communicate with Provider Strategy & Solutions (PS&S) leadership and internal stakeholders on account status to facilitate proper internal support of account management efforts to ensure that the resulting final contract supports Premera's operational and strategic goals.
Engage providers to promote the concept and understanding of patient engagement adherence, cost savings preventative programs
Other duties and projects as assigned.

Benefits

Medical, vision, and dental coverage with low employee premiums.
Voluntary benefit offerings, including pet insurance for paw parents.
Life and disability insurance.
Retirement programs, including a 401K employer match and a pension plan that is vested after 3 years of service.
Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs.
Generous paid time off to reenergize.
Tuition assistance for both undergraduate and graduate degrees.
Employee recognition program to celebrate anniversaries, team accomplishments, and more.
Commuter perks make your trip to work less impactful on the environment and your wallet.
Free convenient on-site parking.
Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
Challenge someone to a game of shuffleboard or ping pong while on campus.