- Negotiates provider contracts with some involvement or peers or management as needed.
- Manages the provider relationship, including the strategic direction of the provider and changes in business needs.
- Knows and applies the fundamental concepts, practices and procedures of provider contract negotiation with some involvement of peers or management.
- Manages negotiations against established budget targets and contract negotiations in a timely fashion to meet corporate deadlines.
- Prepares management reports to summarize status, findings and solutions of contract negotiations.
- Investigates complex data in conjunction with network finance or other corporate analysts.
- Interprets contracting and financial data for providers.
- Extensive in-depth knowledge of complex payment methodologies, coding and reimbursement standards, contract language standards, contract compliance issues, claims processing operations, medical management practices, and quality standards and clinical initiatives that impact provider performance.
- Ensures that contracts and payment terms are negotiated in accordance with established contract administration policies and procedures, including regulatory requirements.
- Defines business problems and opportunities for providers and identify strategies and tactics to provide solutions as well as to maximize the value of the provider contract to Blue Cross.
- Works under general guidance, prioritizes and organizes own work to meet deadlines.
- Bachelor's degree.
- Displays strong ability to lead cross-functional teams.
- Ability to work across systems and functions to facilitate solutions and capabilities development.
- Demonstrated creativity in solution development with strong sense of urgency.
- Positive thinker/self starter.
- Skillful negotiator, ability to influence internal and external customers.
- 3+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
- The position is able to work on multiple priorities, deadlines, and has the ability to adapt to change.
- Excellent communications and interpersonal skills (internal/external).
- Excellent organizational skills.
- MS office applications experience.
- Excellent analytical skills.
- Strong problem resolution skills.
- Ability to develop and perform audit processes.
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Provider Partner - Eagan, United States - Blue Cross and Blue Shield of Minnesota
Description
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.
How Is This Role Important to Our Work?
This highly visible position is responsible for negotiating provider contracts by developing provider relationships and negotiating renewals and new contracts with providers. This position coordinates work with provider contract administration, contracts and compliance, credentialing, provider finance and other departments or divisions of Blue Cross. It is critical for this role drive results for the Provider Partner team through closing of contracts and sharing the voice of the provider internally.
A Day in the Life:
Nice to Have:
Required Skills and Experiences:
Role Designation:
Hybrid RemoteRole designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.
Make a difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
