LTSS Provider Network Manager II - BlueCross BlueShield of Tennessee
Knoxville, TN
About the Job
Maintains relationships with providers by daily interaction and delivers technical assistance to correct any errors and control risks for the insurer and provider.
Job Description:
Job Responsibilities
+ Identifying educational topics, methods, and strategies to enhance compliance throughout the provider network.
+ Implementing, supporting, and monitoring provider programs and enterprise initiatives
+ Implementing processes and changes needed to maintain regulatory compliance, contract compliance or to improve quality.
+ Handling escalated provider enrollment processing and problem resolution.
+ Leading data reporting and analysis projects to monitor financial and service relations with providers.
+ Consulting with providers on delivery, training and support related issues, identifying opportunities for enhancement and recommending solutions.
+ Able to travel to provider offices or conduct virtual meetings as required.
Job Qualifications
_Education_
+ Bachelors degree in business or healthcare or relevant field or equivalent work experience required
_Experience_
+ 3 years - Experience in provider relations and network development with emphasis on healthcare education and reimbursement.
_SkillsCertifications_
+ Ability to speak in public and conduct effective presentations.
+ Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
+ Demonstrated ability to interpret and translate technical and/or or complex concepts into information meaningful to project team members and/or business personnel.
+ Proficient in Microsoft Office (Outlook, Word, Excel, Access and PowerPoint)
+ Accuracy and attention to detail
+ Effective time management skills
+ Excellent oral and written communication skills
+ Strong interpersonal and organizational skills
+ Strong analytical skills
+ Ability to manage multiple projects and priorities
+ Positive attitude, self-driven, engaging, proactive, results drive
+ Knowledge in Medical terminology
+ Knowledge of contract language and reimbursement methodologies, managed care business processes, case-mix adjustment, medical terminology, utilization management and applications for claims payment, required.
_License_
+ Valid Driver's License
Job Specific Requirements:
+ Needs to be located in the Johnson City OR Knoxville area OR in between these two cities. This is Hybrid position.
+ Able to travel to provider offices.
+ Preferred facets 6 months
+ Preferred care advance 6 months
Preferred Skills:
Number of Openings Available:
1
Worker Type:
Employee
Company:
VSHP Volunteer State Health Plan, 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 (https://www.bcbst.com/docs/equal-employment-opportunity.pdf)
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.
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/nicotineand/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.
About Us
As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health for over 65 years. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow.
BCBST is a remote-first organization with many employees working primarily from their homes. Each position within the company is classified as either fully remote, partially remote, or office based.
BCBST hires employees for remote positions from across the U.S. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense. If the applicant moves to Chattanooga, TN, they may be eligible for relocation benefits.
Job Description:
Job Responsibilities
+ Identifying educational topics, methods, and strategies to enhance compliance throughout the provider network.
+ Implementing, supporting, and monitoring provider programs and enterprise initiatives
+ Implementing processes and changes needed to maintain regulatory compliance, contract compliance or to improve quality.
+ Handling escalated provider enrollment processing and problem resolution.
+ Leading data reporting and analysis projects to monitor financial and service relations with providers.
+ Consulting with providers on delivery, training and support related issues, identifying opportunities for enhancement and recommending solutions.
+ Able to travel to provider offices or conduct virtual meetings as required.
Job Qualifications
_Education_
+ Bachelors degree in business or healthcare or relevant field or equivalent work experience required
_Experience_
+ 3 years - Experience in provider relations and network development with emphasis on healthcare education and reimbursement.
_SkillsCertifications_
+ Ability to speak in public and conduct effective presentations.
+ Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
+ Demonstrated ability to interpret and translate technical and/or or complex concepts into information meaningful to project team members and/or business personnel.
+ Proficient in Microsoft Office (Outlook, Word, Excel, Access and PowerPoint)
+ Accuracy and attention to detail
+ Effective time management skills
+ Excellent oral and written communication skills
+ Strong interpersonal and organizational skills
+ Strong analytical skills
+ Ability to manage multiple projects and priorities
+ Positive attitude, self-driven, engaging, proactive, results drive
+ Knowledge in Medical terminology
+ Knowledge of contract language and reimbursement methodologies, managed care business processes, case-mix adjustment, medical terminology, utilization management and applications for claims payment, required.
_License_
+ Valid Driver's License
Job Specific Requirements:
+ Needs to be located in the Johnson City OR Knoxville area OR in between these two cities. This is Hybrid position.
+ Able to travel to provider offices.
+ Preferred facets 6 months
+ Preferred care advance 6 months
Preferred Skills:
Number of Openings Available:
1
Worker Type:
Employee
Company:
VSHP Volunteer State Health Plan, 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 (https://www.bcbst.com/docs/equal-employment-opportunity.pdf)
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.
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/nicotineand/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.
About Us
As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health for over 65 years. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow.
BCBST is a remote-first organization with many employees working primarily from their homes. Each position within the company is classified as either fully remote, partially remote, or office based.
BCBST hires employees for remote positions from across the U.S. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense. If the applicant moves to Chattanooga, TN, they may be eligible for relocation benefits.
Source : BlueCross BlueShield of Tennessee