PLEASE NOTE: This position is Remote with some geographic restrictions. To be hired for this position, you MUST live in one of the following states:
Alabama (AL), Arkansas (AR), Florida (FL), Georgia (GA), Mississippi (MS), Missouri (MO), North Carolina (NC), South Carolina (SC), Tennessee (TN), Virginia (VA).
Provides oversight and guidance for delivering systematic programs that help providers address challenges and support differentiated service experiences for customers.
Job Description:
BlueCross, as a federal contractor, may be required to implement a COVID-19 vaccine mandate.
Job Responsibilities
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Implementing and monitoring reimbursement processes; coordinating provider incentives programs and activities.
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Collaborating with providers to help foster positive relationships; maintaining relations with regulators to stay current on all provider program information.
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Coordinating activities with all relevant areas within the organization to ensure provider program strategies are supported and consistent with other initiatives.
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Developing and managing all provider programs, assuring their integrity and adequacy in meeting customer needs.
Job Qualifications
Education
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Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment
Experience
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8 years - Experience in financial management required
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5 years - Experience negotiating complex contracts using a variety of payment methodologies that create mutually productive partnerships with providers required
Skills\Certifications
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Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
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Outstanding negotiation, presentation, and facilitation skills
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Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint)
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Must be a team player, be organized and have the ability to handle multiple projects
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Excellent oral and written communication skills
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Strong interpersonal and organizational skills
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In depth knowledge of the health care industry, including prior history with provider contracting in at least one pay-for-value concept such as bundled payments, P4P contracting or provider performance incentives.
Job Specific Requirements:
Preferred Experience/Knowledge with the following:
QCIP Programs, Value Based Contracts, Provider Engagement, NCQA and HEDIS
Travel Required
Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).
- The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.
Preferred Skills:
Number of Openings Available:
1
Worker Type:
Employee
Worker Sub-Type:
FlexHome
Company:
BCBST BlueCross BlueShield of Tennessee, Inc.
Applying for this job indicates your acknowledgement and understanding of the following statements:
BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.
Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:
BCBST's EEO Policies/Notices
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
All applicants will be advised that BlueCross, as a federal contractor, may be required to implement a COVID-19 vaccine mandate.
Tobacco-Free Hiring Statement
To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.
Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.