DurhamRecruiter
the smart solution for Durham jobs

Strategic Provider Relationship Consultant

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

Job Description:

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.

HIRING REQUIREMENTS

* 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

HIRING PREFERENCES

* 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

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Professions Jobs


CDL-A Owner Operator Truck Driver
Description: New drivers are now eligible for 2,500 in sign-on incentives TransAm Trucking, a leading refrigerated carrier, has owner operator truck driver opportunities available now for CDL-A drivers Apply today (more...)
Company: Trans AM Trucking
Location: Chapel Hill
Posted on: 02/24/2019

CDL A Team Driver - 100% No Touch Freight!
Description: Benefits br br Late model equipment - Fully loaded br Up to 10,000 Sign-on bonus br Increased pay br 5,000 miles per week
Company: Transco Lines, Inc.
Location: Greenville
Posted on: 02/24/2019

Lease to Own Truck Driver - Runs out of North Carolina! (Chapel Hill,N
Description: Lease to Own Truck Driver Opportunity Runs out of North Carolina Ride with U.S. Xpress today We are now hiring lease to own truck drivers for runs out of North Carolina with low weekly truck payments. (more...)
Company: US Xpress
Location: Chapel Hill
Posted on: 02/24/2019


CDL A Team Driver - 100% No Touch Freight!
Description: Benefits br br Late model equipment - Fully loaded br Up to 10,000 Sign-on bonus br Increased pay br 5,000 miles per week
Company: Transco Lines, Inc.
Location: High Point
Posted on: 02/24/2019

Experienced Heavy Duty Diesel Mechanic
Description: Academy Bus , an industry leader in motorcoach transportation has an immediate opening for an-- Experienced Heavy Duty-- Diesel Mechanic --in-- Durham , NC.-- We are looking for a highly motivated technician (more...)
Company: Academy Bus
Location: Cary
Posted on: 02/24/2019

CDL-A Truck Driver: Earn $80,000 yr or more, Top-Notch Benefits
Description: National OTR Drivers FEATURING OUR NEW PAY INCREASE Crete Carrier is seeking professional truck drivers to join their national over the road fleet . Home time options include 12 and 21 days out. Apply (more...)
Company: Crete Carrier
Location: Chapel Hill
Posted on: 02/24/2019

Online Automotive Consultant
Description: Online Automotive Consultant This position is with Mommy Jobs Online, so please visit mommyjobsonline.com to apply and get registered on our site directly Our agents who are currently servicing this (more...)
Company: Mommy Jobs Online
Location: Chapel Hill
Posted on: 02/24/2019

CDL A Delivery Truck Driver
Description: Company: Sysco Virginia Location: US-VA-Lynchburg Zip Code: 24504 Minimum Level of Education: Not Applicable Minimum Years of Experience: 0-1 Position Type: Non-Exempt Travel Percentage: 0 More information (more...)
Company: Sysco
Location: Lynchburg
Posted on: 02/24/2019

Work at Home Benefit Consultants - Training Provided
Description: Nation's premier provider of healthcare access is looking for motivated self starters to enjoy a career with our company. Our company has been in business for 24 years. Our health care
Company: AmeriPlan
Location: Cary
Posted on: 02/24/2019

Owner Operator, Team CDL A, Drop & Hook
Description: Division Overview: Forward Air's Dedicated Premium Truck Load Services division offers prospective Team Owner Operators a unique over-the-road experience by combining significant per-mile compensation, (more...)
Company: Forward Air
Location: Cary
Posted on: 02/24/2019

Log In or Create An Account

Get the latest North Carolina jobs by following @recnetNC on Twitter!

Durham RSS job feeds