Resp & Qualifications
OVERVIEW: This position reports to the Manager, Provider Contracting and is responsible for contracting and recruiting network providers. Responsibilities include strategic project planning, the negotiation of network participation agreements with health systems and significant/key providers, oversight of Network Specialists and/or Contract Managers and Coordinators, and the development of CareFirst networks.
PRINCIPAL ACCOUNTABILITIES: Under the general guidance of the Manager, the Supervisor will:
• Evaluate the geographic, financial and network access impacts of individual provider agreements.
• Prepare negotiation strategies for management’s review and approval.
• Responsible for more complex contracts and negotiations.
• Compare network access of CareFirst to commercial competitors.
• Determine alternate access for similar provider types and compare quality of care measures.
• Quantify appropriate financial terms commensurate with negotiation leverage.
• Draft most-favored-nation clauses to minimize care costs and ensure a competitive advantage.
• Negotiate all network contract terms with providers.
• Prepare all proposals, analyses and non-standard contract amendments.
NETWORK MANAGEMENT AND DEVELOPMENT:
• Track and analyze provider-specific requests in a timely manner.
• Recruit providers in support of corporate projects, and in support of existing and prospective CareFirst accounts.
• Develop all networks to obtain and/or maintain a competitive advantage for all specialties throughout the entire CareFirst service area.
• Dissuade providers from terminating their participation agreements.
SUPERVISION AND STRATEGIC PROJECT PLANNING Contribute to the planning of strategic objectives/projects for the department.
• Provide supervision to Network Specialists and/or Contract Managers and Coordinators for negotiation strategies and day-to-day activities.
• Coordinate department activities to meet Corporate Project deliverables.
• Provide oversight to the implementation process of non-standard contracts with Provider Reimbursement and Provider Information & Credentialing.
• Assists Manager with direction and vision for policy and quality standards for all departmental work; inventory trends and impacts; associate actions plans; tactical planning, implementation, monitoring and reporting.
ANALYSIS AND MAINTENANCE:
• Manage non-standard contract provisions and future changes.
• Monitor healthcare industry changes and trends.
• Recommend providers for termination as appropriate.
• Identify opportunities for performance improvement and financial savings.
• Assure contracts comply with all regulatory and statutory mandates, corporate policies and BlueCross BlueShield Association requirements.
• Draft and mail amendments to comply with jurisdictional changes.
• Work with the Legal and Corporate Communications departments to develop appropriate responses to contract issues.
• Ensure that all contracts are uploaded into Contract Management system, as appropriate.
• Build and maintain positive provider relationships.
• Act as a CareFirst liaison with providers and facilitate effective communication.
• Participate with interdepartmental teams to improve provider service and satisfaction levels.
Bachelor’s degree in business or health care administration. In lieu of Bachelor’s degree, must have 4 years related work experience.
5 years experience with progressively increasing responsibility in provider recruitment and/or provider relations.
The applicant must have a minimum of 2 years experience in the department as a Network Specialist or Contract Manager, and exceed the job requirements (or proven experience and performance of a similar position outside the department or company) .
Demonstrated leadership skills including the ability to: 1) train, coach and motivate the performance of others; 2) positively impact the performance of close colleagues as a trusted consultant.
Effective time and project management skills to be able to plan and monitor activities to ensure achievement of organizational goals.
Effective human relations skills in order to lead project teams towards goal attainment.
Ability to build and maintain a high performing team, providing coaching and mentoring to indivduals and team members.
Thorough knowledge of health care financial matters and third party payment methodologies.
Understanding of contractual documents and ability to effectively communicate terms to providers.
Working knowledge of provider community, market and its underlying financial dynamics.
Excellent verbal and written communication skills.
PC skills, including financial analysis and modeling.
Effective negotiation skills.
Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Previous experience as Supervisor or Team Lead.
Masters degree in business or health care administration.
Significant work experience in job related area.
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 11/07/2019
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The physical demands described here are representative of those that must be met by an employee to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
The employee is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The employee must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship