Provider Network Manager I/II

Blue Cross of Idaho•Meridian, ID

10d

About The Position

Develop and maintain positive working relationships with contracted providers. Actively audit and monitor financial performance of all assigned providers to ensure network sustainability. Analyze, review, and project financial impact of contract arrangements. Initiate and maintain effective communication channels with internal business partners. Ensure accurate implementation and administration of contracts. We are looking for a Provider Network Manager with: Level I: 4 years’ provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience Level II: 6 years’ provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience Education: Bachelor’s degree or equivalent work experience (Two years’ work experience is equivalent to one year of college) What a day of a Provider Network Manager may look like: Analyze, review, and project financial impacts of network arrangements. Develop and maintain cost efficient networks and/or programs and identify areas of opportunity for greater efficiency and risk mitigation. Ensure accurate implementation and administration of executed networks and/or programs. Implement reimbursement strategies designed to control healthcare costs. Use data from multiple sources to recommend innovative payment initiatives and methodologies. Prepare and present financial performance reports on assigned networks to leadership. Formulate, analyze, coordinate, and negotiate contracts with provider networks. Maintain documentation related to processes and procedures, training materials, program descriptions and technical program requirements. Prepare and present to healthcare organizations, clients, and internal business partners. Established productive, professional provider relationships with key partners and maintains provider satisfaction through assessment and response to on-going provider needs. May identify provider payment or utilization variations and take action to resolve. Communicates variations to leadership. Perform other duties and responsibilities as assigned.

Requirements

Level I: 4 years’ provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience
Level II: 6 years’ provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience
Bachelor’s degree or equivalent work experience (Two years’ work experience is equivalent to one year of college)

Responsibilities

Analyze, review, and project financial impacts of network arrangements.
Develop and maintain cost efficient networks and/or programs and identify areas of opportunity for greater efficiency and risk mitigation.
Ensure accurate implementation and administration of executed networks and/or programs.
Implement reimbursement strategies designed to control healthcare costs.
Use data from multiple sources to recommend innovative payment initiatives and methodologies.
Prepare and present financial performance reports on assigned networks to leadership.
Formulate, analyze, coordinate, and negotiate contracts with provider networks.
Maintain documentation related to processes and procedures, training materials, program descriptions and technical program requirements.
Prepare and present to healthcare organizations, clients, and internal business partners.
Established productive, professional provider relationships with key partners and maintains provider satisfaction through assessment and response to on-going provider needs.
May identify provider payment or utilization variations and take action to resolve.
Communicates variations to leadership.
Perform other duties and responsibilities as assigned.