Submission for the position: Network Development Contractor - (Job Number: 21876)
https://bcbsfl.taleo.net/careersection/jobdetail.ftl?job=21876&lang=en
Network Development Contractor
GuideWell is a health solutions company on a mission to help people and communities achieve better health! Florida Blue is a part of GuideWell and the largest insurer in the state of Florida. As a Network Development Contractor, you would work on ensuring members have an adequate choice of providers to select as their healthcare provider. In this role you can expect to be a driver for a positive healthcare journey for our members and cause memorable impacts in their life. As an employee of Florida Blue, you would receive fantastic benefits, competitive pay, and additional benefits such as 401K, PTO, etc.
The essential functions listed represent the major duties of this role, additional duties may be assigned:
• Negotiate contract terms and establish contractual relationships with providers with moderate complexity
• Coordinate the implementation of contractual arrangements with internal business partners
• Implement corrective action to enhance network performance and monitor results
• Establish and maintain positive relationship for assigned providers
• Issue resolution
• External execution of operational initiatives: self- service tools, retail, projects
• Implement medical cost management initiatives
• Proactively communicates and trains provider on administrative policies, business processes, capabilities and initiatives
• Perform site visits to address member complaints/potential quality issues
• Support professional organization relationship events
• Execute provider facing deliverables for key projects
Required Work Experience
• 5 years developing and maintaining provider contracts and/or relationships
work experience or equivalent combination of transferable experience and education.
• Related Bachelor’s degree or additional related equivalent work experience
• Experience of provider payment programs and billing practices
• Experience of insurance products and network configurations
• Excellent verbal and written communication skills
• Experience in issue resolution with ancillary and hospital based providers
• Experience interpreting analytical data
• Valid Driver License Frequent local travel with occasional overnight stays
Preferred Qualifications
• Experience using BCBSF systems (Diamond, Provider Connect, Siebel)
• 3 or more years of experience negotiating standard and non-standard provider contracts
• Experience negotiating with third-party representatives, hospital-based provider organizations and or ancillary provider organizations
• Experience using the Network Management Simulation Tool (SIM) Medicare and Medicaid experience
• Masters Degree
• Experience negotiating value based contracts
• Experience using various provider payment methodologies
• Experience negotiating risk contracts, shared savings, and pay for performance programs.
We are an Equal Opportunity Employer/Protected Veteran/Disabled.
United States-Florida-Tampa
United States-Florida-Clearwater, United States-Florida-Sarasota, United States-Florida-Panama City, United States-Florida-Pensacola, United States
Florida Blue
Oct 2, 2020, 10:59:00 PM
Schedule: Full-time Location(s): United States-Florida-Tampa