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Strategic Provider Relationship Consultant

Company: Blue Cross and Blue Shield of North Carolina
Location: Durham
Posted on: February 14, 2019

Job Description:


Implements strategic activities targeted at professional, institutional and ancillary providers for a specific geographic region. Responsible for ensuring adherence to the negotiated agreement for all provider types for all BCBSNC products. Primarily responsible for: 1) Building strong strategic relationships with key decision makers in the provider community enabling BCBSNC to become market leading. 2) Retaining a competitive provider network through innovative approaches to reducing provider transaction costs and 3) Attaining best in claim status for relationship management and service satisfaction for the NC provider community. 4) Through collaboration with other BCBSNC departments responsible for provider service, deployment of a comprehensive service model resulting in higher provider satisfaction, reduction of duplicates service offerings and consistent provider communication messages. 5) Responsible for provider contracting activities/duties for select statewide providers for specific corporate initiatives such as point of care lab technology, virtual care, and other enterprise provider centric initiatives once approved by senior management.

* Support and implement a three year plan representing:

1. Strategic focus areas within NM

2. Clear, concise and practical goals and objectives

3. Supporting metrics and tactical plans

* Support the development and promote the implementation of new provider payment models and reimbursement methodologies for managed care programs and products. Conducts financial and other quantitative analysis to ensure agreements are implemented efficiently and correctly.

* Analyzes the negotiated agreement to ensure implementation and reimbursement is completed accurately. Assists management with analysis and prioritization of areas of implementation and predict with reasonable accuracy expected financial results.

* Support the development and make recommendations for effective formats for providing education and programs to the provider community. Mediums available include printed materials, verbal and written presentations, and web based formats.

* Responsible for managing a strategy to schedule, plan and visit specific network providers to:

o Present or reiterate the BCBSNC medical and/or administrative policies and procedures;

o Address provider inquiries and concerns

o Disseminate information

o Address specific non-compliance issues with BCBSNC agreements and coordinate the required corrective action.

* Support the development and execution of meaningful provider workshops and education events.

* Support the development and execution of methods to gauge provider satisfaction with education staff, materials, and processes. Analyze and execute improvement plans.

* Timely management of resolution of large-scale issues for key providers. Makes recommendations to BCBSNC leadership on process improvements to enhance provider partner relationships.

* Identify, analyze and resolve complex high dollar operational issues impacting professional, hospital, ambulatory surgical center, and ancillary providers. Use the appropriate Stakeholder Service Model to increase provider satisfaction and reduce administrative costs.

* Identify opportunities to control medical expense and deploy action plans to accomplish stakeholder-specific or regional medical expense goals.

* Represent BCBSNC in critical stakeholder meetings to address stakeholder administrative inefficiencies and to ensure contractual compliance. Participate in negotiations with stakeholders as needed.

* Assist in the analysis of all products, identify any deficiencies and make recommendations for improvement.

* Provide analysis and feedback for technologies, trends, best practices and service offerings to incorporate them into overall stakeholder business solutions.

* Plan all on-site visits to stakeholders to educate on BCBSNC medical or administrative policies and procedures. Address stakeholder concerns and non-compliance contract/administrative issues. Coordinate the required corrective actions.

* Partner with assigned stakeholders to understand their processes, procedures and systems as they relate to the way they conduct business with BCBSNC.

* Develop and maintain extensive knowledge of key stakeholders and/or regional territories. Leverage knowledge base to forward Enterprise relationships with stakeholders.

* Track stakeholder issues for root-cause analysis, escalation, and closure. Document issue resolution using issue resolution protocol.

* Comply with state, federal and BCBSA regulations governing stakeholders and suggests implementation of any product, process or system modifications to ensure compliance.


* Undergraduate degree, in Health Administration or Health Education, Business Administration or an appropriate managed care related field

* 3 years experience in an organized healthcare delivery system that includes provider network education

* If no degree, 5 years experience in an organized healthcare delivery system that includes provider network education


* Experience in provider interactions with institutional, professional and ancillary providers.

* Experience in provider contracting preferred.

* Experience in member or employer group service.

* Knowledge of institutional and ancillary pricing, health care finance, hospital and ancillary payments

* Strong negotiation skills

* Public speaking and presentation skills to relate effectively with providers, administrators and staff

* Interpersonal skills

* Demonstrated time management and organizational skills

* Excellent written and verbal communication skills

* Problem solving and decision-making skills

* Efficient in Microsoft Office Suite

* Ability to effectively manage multiple high priority and high profile tasks/provider relationships

CPC (professional and outpatient) and CCS (inpatient) coding.

Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities.

Keywords: Blue Cross and Blue Shield of North Carolina, Durham , Strategic Provider Relationship Consultant, Professions , Durham, North Carolina

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