Sr Manager Provider Network Contracting
Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.
Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Negotiates and contracts with large, key healthcare providers (hospitals, physicians, etc.) and manages contracting staff whose responsibility is to contract and negotiate with physicians and ancillary providers.. Serves as the primary provider contracting contact and resource for the staff. Provides oversight, direction, development, problem resolution and leadership for all contracting activities for the team. Ensures contracting department goals are achieved as assigned, including meeting contract financial targets and incorporating value based reimbursement as appropriate.
- Manage the day-to-day activities of a team of employees engaged in provider contracting functions.
- Using strong negotiation skills, independently contract with large, key healthcare providers to meet targeted goals.
- Key contact for General Manager(s) to support their network requirements to meet their business goals.
- Understand and interpret various analyses of the financial structure of contracts to ensure it meets financial targets.
- Direct, evaluate, define and improve the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines for provider contracting.
- Administer, interpret and maintain current working knowledge of the required BCBSAZ contracting systems, procedures, forms and manuals as related to the assigned area of responsibility.
- Keep team informed of new or updated contracting methodologies, contract languages, and contracting systems, procedures, forms and manuals through staff meetings and verbal and written communications.
- Responsible for the review, update and accuracy of department documentation, computer files, policies and procedures related to the department goals and objectives.
- Provide guidance, motivation and encouragement to subordinates, conduct performance evaluations, identify and coordinate training needs, make determinations regarding disciplinary actions.
- Set contracting goals for subordinates and ensure sufficient training and oversight is in place to achieve such goals.
- Consult and coordinate with various internal departments, external Blue Plans or business partners, providers, business entities, and government agencies as a representative of the area of responsibility.
- Identify, research, process, resolve and respond to provider inquiries and correspondence via telephone, written communication and/or in person.
- Evaluate and make recommendations in regard to employment decisions.
- Monitor and investigate computer system issues.
- Serve as a team leader, facilitator, or team member of the quality management process when requested.
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Perform all other duties as assigned.
Skills / Requirements
Required Work Experience
- 5 years of experience in healthcare field
- 4 years of experience in a management role in the provider relations or provider contracting field
- High-School Diploma or GED in general field of study
- Valid Arizona Driver License with an acceptable driving record
Preferred Work Experience
- 8 years of experience in a management role in the provider relations or provider contracting field
- Bachelor's Degree in business, finance or other field of study
Required Job Skills
- Intermediate skill in use of office equipment including copies, fax machine, scanner and telephones
- Intermediate PC proficiency
- Intermediate proficiency with word processing, spreadsheet and database software
Required Professional Competencies
- Proven track record of negotiating difficult contracts to meet targeted goals.
- Strong ability to understand and interpret financial data and analyses.
- Ability to maintain confidentiality and privacy of data.
- Ability to plan, organize and manage the work of all assigned personnel.
- Proven leadership and management skills.
- Maintain confidentiality and privacy of data
- Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data
- Capable of investigative and analytical research
- Compose and dictate a variety of business correspondence
- Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards
- Establish and maintain working relationships in a collaborative team environment
- Ability to plan, organize and manage the work of all assigned personnel
Required Leadership Experience and Competencies
- Make use of employees' skills and abilities to deliver business objectives
- Use available information to focus the team's activities, identify priorities and strengthen team effectiveness