Blue Cross and Blue Shield of Louisiana Jobs

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Blue Cross and Blue Shield of Louisiana Lead Provider Contract Negotiator in Baton Rouge, Louisiana

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.

Please note that effective Jan. 4, 2022, Blue Cross and Blue Shield of Louisiana will require any employee who enters any of our offices or who interacts in person with anyone for company business purposes to be fully vaccinated for COVID‑19, unless legally entitled to a reasonable accommodation related to religious or medical exemptions. Please note this is subject to change at any point in time to ensure compliance with company policy or government mandates.

Residency in or relocation to Louisiana is preferred for all positions.

POSITION PURPOSE

Serves as the Lead Health Plan contract negotiation representative for hospital systems with multiple providers, large and/or complex providers and is responsible for negotiating competitive provider reimbursement and terms within all contracts to result in improving the cost competitive position of BCBSLA in the marketplace. Fully understands and negotiates value based contracts. The position focuses upon complex and intermediate level provider contracting with incumbents dedicating at least 65% of their time to achieving contract negotiation goals.

Mentors less experienced Provider Negotiator staff. Serves as the Plan representative responsible for establishing and maintaining favorable relationships with providers and resolving provider issues related to their contracts. Makes recommendations to management as it relates to network development, network strategies for implementation and maintenance of contracts, policies, and procedures.

NATURE AND SCOPE

  • This role does not manage people

  • This role reports to this job: VP, Provider Networks and Contracting

  • Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with:Provider personnel at all levels including the provider’s CEO, CFO and legal counsel and provider’s consultants, all staff of the Provider Network, Provider Contracting and Provider Negotiations areas, all Plan personnel with specific interaction required for key personnel within each division, Blue Cross and Blue Shield Association (BCBSA) personnel, Plan personnel from all other BCBS Plans, and leaders of the various health care organizations.

QUALIFICATIONS

Education

  • Bachelor's degree in Business, Healthcare, Finance, Marketing, Communications, Psychology or in a related field is required.

  • Four years of related experience can be used in lieu of a Bachelor’s degree.

Work Experience

  • 7 years of experience in the healthcare or managed care industry or a related professional services, consulting or law firm focusing on the establishment and maintenance of hospital and facility managed care contractual agreements is required.

  • Strong preference for prior value based healthcare contracting experience.

  • Prefer mediation, arbitration, legal and/or consulting experience.

  • Experience interacting with providers face-to-face and maintaining business relationships in a managed care setting and managed care hospital and facility required.

  • Proven and effective contract negotiation experience required; prefer experience with large hospital contracts.

  • Experience negotiating multi-provider contracts with hospital systems and negotiating value based reimbursement contracts is required.

  • Experience reading and drafting contractual language that reflects the negotiated terms agreed to.

  • Leadership experience preferred.

  • Experience may run concurrently.

Skills and Abilities

  • Must demonstrate thorough understanding of all provider network requirements or have the ability to quickly learn requirements, which include including but are not limited to credentialing and accreditation, network participation, complex reimbursement methodologies, contract performance measures, PLAN quality initiatives; prefer an existing understanding of provider network and corporate initiatives.

  • Must understand the reimbursement and the provider mix in their geographic territories as well as how changes affect member cost share and overall medical spend for the Plan. Understands and works on contracting for value based programs. In lieu of understanding Louisiana territories upon hire, must be knowledgeable of existing territory and Plans with the ability to quickly learn BCBSLA reimbursement and provider mix in Louisiana geographic territories as well as related cost share and medical spending for assigned Plans within 6 months; with a solid understanding within a year.

  • Excellent written and verbal communication and presentation skills are required along with the ability to effectively communicate complex concepts and contracts to all levels of employees and providers.

  • Excellent interpersonal skills are required along with the proven ability to successfully negotiate complex provider contracts, manage hospital/facility contract negotiations, and resolve problems with tact and diplomacy.

  • Must be comfortable and confident with frequent provider-facing interactions (via teleconferencing, in-person meetings, e-mail, and phone).

  • Must have the ability to learn quickly, prioritize and handle multiple competing priorities with successful outcomes.

  • Must have proven problem solving skills and ability to independently analyze and dissect provider contracts, relationships and issues and create workable win-win solutions for both the provider and BCBSLA.

  • Must have proficient skills using PC based applications to develop and report on provider activity using Microsoft Word, Excel, PowerPoint, and Outlook.

  • Must have the ability and willingness to travel for provider on-site visits, association meetings, presentations, etc. Relocation assistance available.

Licenses and Certifications

  • None Required

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

  • Independently negotiates and drafts fee for service and value based contractual language and competitive reimbursement contracts with all types of providers. Contracts pose a mid to high level degree of difficulty and must adhere to corporate standards, goals, and budget.

  • Acts as a professional resource to answer all contractual questions posed by providers and/or internal departments within the organization, including but not limited to, assisting providers within assigned territory with difficult problems that they are unable to resolve through normal/available channels, participating in the dispute resolution process for providers in accordance with Network Policy and Procedures, participating in workshops and in-services, engaging providers to participate in BCBSLA initiatives.

  • Builds effective provider networks and meets with network providers on a regular basis or as needed, to maintain provider satisfaction.

  • Mentors less experienced Provider Negotiations staff and works with internal cross-functional teams to provide senior level guidance and direction all contracts (including value based contracts), regulatory changes, provider relationship management and policy and procedural changes.

  • Provides clear, concise, and timely reporting to management and/or other plan personnel regarding the progress of provider network development including monitoring and reporting significant developments and changes to key administrative provider contacts occurring within the provider community. Ensures the company is appropriately advised and strategically aligned on network issues.

  • Acts as point of contact for providers by monitoring and overseeing the implementation of providers in the network as well as the provision of the materials and paperwork necessary to participate in networks to ensure efficiencies, provider satisfaction and goals of the department for timely set up are met.

  • Maintains current information on all aspects of assigned market including our plan’s competitive position within the market and works with internal departments to maintain or expand BCBSLA’s market share and provider access for members. Anticipates and appropriately reacts to provider closures, acquisitions, market changes.

  • Must be able to multitask in a highly fluid environment.

  • Accountable for complying with all laws, regulations and accreditation standards that are associated with duties and responsibilities.

Additional Accountabilities and Essential Functions

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

  • Perform other job-related duties as assigned, within your scope of responsibilities.

  • Job duties are performed in a normal and clean office environment with normal noise levels.

  • Work is predominately done while standing or sitting.

  • The ability to comprehend, document, calculate, visualize, and analyze are required.

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An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

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Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

JOB CATEGORY: Insurance

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