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Blue Cross of Idaho · 1 month ago

Provider Network Manager I/II

Meridian - Main

Full-time

Onsite

Mid, Senior Level

$76K/yr - $141K/yr

4+ years exp

Blue Cross of Idaho is seeking a Provider Network Manager to develop and maintain relationships with contracted providers and ensure network sustainability. The role involves auditing financial performance, analyzing contract arrangements, and implementing reimbursement strategies.

Health InsuranceInsurance

Comp. & Benefits

H1B Sponsor Likely

Responsibilities

Develop and maintain positive working relationships with contracted providers

Actively audit and monitor financial performance of all assigned providers to ensure network sustainability

Analyze, review, and project financial impact of contract arrangements

Initiate and maintain effective communication channels with internal business partners

Ensure accurate implementation and administration of contracts

Analyze, review, and project financial impacts of network arrangements

Develop and maintain cost efficient networks and/or programs and identify areas of opportunity for greater efficiency and risk mitigation

Ensure accurate implementation and administration of executed networks and/or programs

Implement reimbursement strategies designed to control healthcare costs

Use data from multiple sources to recommend innovative payment initiatives and methodologies

Prepare and present financial performance reports on assigned networks to leadership

Formulate, analyze, coordinate, and negotiate contracts with provider networks

Maintain documentation related to processes and procedures, training materials, program descriptions and technical program requirements

Prepare and present to healthcare organizations, clients, and internal business partners

Established productive, professional provider relationships with key partners and maintains provider satisfaction through assessment and response to on-going provider needs

May identify provider payment or utilization variations and take action to resolve

Communicates variations to leadership

Perform other duties and responsibilities as assigned

Qualification

Provider contract managementProvider reimbursement methodologiesContract negotiationFinancial analysisData analysisRelationship managementCommunication skills

Required

Level I: 4 years' provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience

Level II: 6 years' provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience

Education: Bachelor's degree or equivalent work experience (Two years' work experience is equivalent to one year of college)

Benefits

Paid time off

Paid holidays

Community service and self-care days

Medical/dental/vision/pharmacy insurance

401(k) matching and non-contributory plan

Life insurance

Short and long term disability

Education reimbursement

Employee assistance plan (EAP)

Adoption assistance program

Paid family leave program

Company

Blue Cross of Idaho

Blue Cross of Idaho operates as a health insurance company.

Founded in 1945

Meridian, Idaho, USA

1001-5000 employees

https://www.bcidaho.com/

H1B Sponsorship

Blue Cross of Idaho has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2022 (1)