CareFirst BlueCross BlueShield · 1 month ago
Provider Contracting Manager (Hybrid)
Baltimore, MD
Full-time
Hybrid
Mid, Senior Level
$105K/yr - $194K/yr
5+ years expCareFirst BlueCross BlueShield is seeking an experienced Provider Contracting Manager to oversee network development activities. The role involves managing provider recruiting and contracting for commercial and government programs, ensuring compliance, and handling departmental regulatory filings.
Health CareNon ProfitService Industry
No H1B
Responsibilities
Plan and manage all professional, ancillary, and institutional (non-hospital) contracting and departmental staff activities for commercial business and government programs and new networks. This includes negotiations, financial quantification, network impacts, qualification and competitive analyses, implementation and monitoring of all non-standard professional contracts and single case agreements
Manage professional, ancillary, and institutional (non-hospital) network development and recruitment projects. This includes recruitment of professional, ancillary, and institutional (non-hospital) providers in support of business expansion including government programs, corporate projects and Sales department requests. Key functions of proactive recruitment are trending participation levels, identifying network deficiencies/gaps and ongoing reviews for competitive access
Maintain standard professional, ancillary, and institutional (non-hospital) provider agreements, update contract language and draft amendments
Compliance for EEO/AAP and all other CareFirst compliance responsibilities. Ensure that all associates complete the online compliance training and certifications
Submit all departmental regulatory filing and reports by the associated statutory deadlines. Operate department within the expected federal and state legal and regulatory requirements
Qualification
Required
Bachelor's Degree in Finance, Accounting, Health Care or Business Administration OR In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience
5 years in the health care or health insurance industry
1 year supervisory experience or demonstrated progressive leadership experience
Strong interpersonal skills
Ability to work independently, as well as a member of a team
Ability to maintain effective interpersonal relationships
Excellent communication skills both written and verbal
Proficient in Microsoft Office programs
Deep understanding of multiple reimbursement methodologies used in healthcare provider contracting
Knowledge of provider billing and coding mechanisms
Negotiation skills
Strong analytical skills: able to transform data into clear and relevant information
Working knowledge of medical insurance and managed care principles
Excellent organizational skills and attention to detail
Effective presentation, negotiation and influencing skills to interface with all levels of management and suppliers
Working knowledge of provider community, market and its underlying financial dynamics
Familiarity with general contracting terms and concepts such as privacy and confidentiality, indemnification, insurance, non-disclosure, and remedies and dispute resolution
Strong follow through and problem-solving skills needed
Knowledgeable of CPT and ICD-9 coding systems
Exhibits interest in an understanding of health economics
Embraces the corporate mission to ensure access to affordable care and applies clinical knowledge and skills with the business operations framework
Strong financial acumen
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
Must be eligible to work in the U.S. without Sponsorship
Preferred
Advanced degree as evidenced by MBA, CPA or Nursing Degree
Benefits
Comprehensive benefits package
Various incentive programs/plans
401k contribution programs/plans
Company
CareFirst BlueCross BlueShield
CareFirst. It’s not just our name. It’s our promise.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Ja'Ron Bridges
Interim President and Chief Executive Officer
Doba Parushev
Vice President, Healthworx Ventures
Recent News
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