Blue Cross and Blue Shield of Louisiana Provider Contract Administrator 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 implemented a policy requiring 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. At this time, that policy is suspended and vaccination is not required to enter our facilities. Please note this is subject to change at any point in time to ensure compliance with company policy or government mandates and certain client facing roles may have separate protocols.
Residency in or relocation to Louisiana is preferred for all positions.
This position is responsible for the development and maintaining of provider contracts and assisting the Network Administration division through answering provider questions, projects and URAC accreditation.
NATURE AND SCOPE
This role does not manage people
This role reports to this job: Director, Provider Contracting
Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with:Provider personnel at all levels and their related associations and agents, all staff of the Network Administration division, all Plan personnel, Blue Cross and Blue Shield Association (BCBSA) personnel, Plan personnel from all other BCBS Plans, and leaders of the various health care organizations.
Bachelor's Degree in business, health care administration or related field required
Four years of related experience can be used in lieu of a Bachelor’s degree.
2 years of experience in the health care industry with a focus in the area of maintenance of contractual agreements customer interaction and conflict resolution, e.g. provider, subscriber, broker/agent, etc. is required
BCBSLA experience is preferred
Skills and Abilities
Ability to create and manage project plans through completion, provides creative solutions to operational problems, and possesses excellent human relations.
Excellent written and oral communication skills.
Ability to respond in a professional, positive and consistent fashion to stressful situations while dealing with the public.
Excellent human relations skills to address, handle and coordinate multiple tasks simultaneously with tact and in a diplomatic manner.
Ability to use PC and mainframe based applications (Microsoft Office, Access, FOCUS).
Ability to produce quality, timely results while handling multiple projects often requiring extended working hours.
Licenses and Certifications
- None Required
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Develops and maintains provider contract templates and network development procedures in accordance with state, federal and accreditation guidelines, policies and procedures, claims adjudication and the subscriber contracts. Works closely with the Legal department in the drafting of new contract language, with minimal supervision. Tracks all non-standard provider contracting arrangements and works with Network Administration staff to ensure deviations from standard contract language are being appropriately administered in the claims system. Designated as primary divisional contact for contract related issues. Administers the above through the execution and maintenance of databases.
Handles Tier 2 and Ancillary provider questions, provides explanation of educational materials and policies to maintain provider contract compliance and create efficiencies among Network Development.
Proactively works with appropriate areas of the company to identify practices and issues that affect provider networks and their ability to effectively and efficiently deliver health care services to Plan members. Identifies impediments to operational excellence and develops solutions, through development, technology research and discussions with staff for change and improvement.
Implements projects and action plans related to provider network development.
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.
An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
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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