Blue Cross and Blue Shield of Louisiana Jobs

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Blue Cross and Blue Shield of Louisiana Provider Network Development Representative 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

This position develops, contracts, maintains, solicits and enhances relationships with facilities, physicians and ancillary providers within designated geographic area(s) to drive business results to improve PLAN’s competitive position including network access and adequacy requirements.

Serves as the PLAN’s representative responsible for establishing and maintaining a professional and positive relationship with providers. Serves as primary contact for soliciting providers participation in PLAN’s and PLAN’s affiliated networks including Medicare, Medicaid and alternative value and quality arrangements.

NATURE AND SCOPE

  • This role does not manage people

  • This role reports to this job: DIRECTOR, PROVIDER NETWORKS

  • Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with:Provider personnel at all levels including CEO, CFO and legal counsel and their related associations and agents, all staff of the Health Services Division, 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, marketing, communications, health care or a related field is required.

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

Work Experience

  • 2 years of experience in the health care industry focusing on the establishment and maintenance of provider networks, both facility and professional.

  • Must build trust and manage the professional business relationship with facilities and professionals (physicians and ancillary providers) as a representative for PLAN.

  • Provider contracting and network experience with other provider types is preferred.

  • Excellent written and oral communication skills, including well-defined and proven public speaking skills.

  • Excellent interpersonal skills and proven complex negotiating skills to address and handle all provider contacts, proven hospital/facility contract negotiations and problem resolution with tact and diplomacy.

  • Must have ability to prioritize and handle multiple competing responsibilities with successful outcomes.

  • Must have and maintain comprehensive knowledge of Louisiana laws and CMS regulations regarding provider network adequacy in commercial and Medicare markets.

  • Must have intimate knowledge of how provider practices operate and how PLAN policies may impact or be impacted by this structure and understanding of various reimbursement methodologies and how it relates to cost containment.

  • Must maintain accurate, up-to-date information regarding key contact, clinical, and other key staff at provider practices and hospitals.

  • Must be able to work efficiently in a collaborative team environment and have experience meeting deadlines and working well under pressure.

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

  • Must have proficient computer skills using Microsoft applications including Word, Excel, PowerPoint, Outlook and Teams.

  • Firsthand knowledge and experience with the icertis Contract Management System is preferred.

  • Must have ability to respond quickly to requests for provider meetings, calls and on-site visits if required.

  • Must have dependable transportation and be willing to travel frequently throughout the state as necessary.

  • Must maintain professionalism at all times and represent BCBSLA in an appropriate manner.

Skills and AbilitiesLicenses and Certifications

  • None Required

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

  • Builds effective provider networks by independently performing outreach with providers to discuss PLAN contracts and perform network solicitation and recommend competitive reimbursement with all provider types that pose a mid to high level degree of difficulty to ensure consistency with corporate goals and budget.

  • Acts as a professional resource to answer all network questions posed by providers and/or internal departments within the organization, including but not limited to, assisting providers with difficult problems unable to be resolved through normal/available channels, participating in dispute resolution process for providers in assigned territory according to Network Policy and Procedure, participating as appropriate for in-services and workshops, and call on network providers on a regular basis or as needed, to help ensure provider adequacy and provider satisfaction.

  • 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 to management to ensure the company is appropriately advised and strategically aligned on network issues.

  • Educates providers regarding PLAN’s network policies and procedures, provider directories, and other provider related topics.

  • 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.

  • Understands how provider-related demographic information changes affect network adequacy to PLAN’s networks.

  • Maintains current information on all aspects of assigned market including PLAN’s competitive position within the market and working within the organization to insure adequate and appropriate provider access for our members.

  • Performs initial problem-solving to address provider network issues in real-time.

  • Collects and provides field-intelligence to leadership. Makes recommendations to PLAN as it relates to network development, network adequacy, and network strategies for implementation and maintenance of provider contracts, policies, and procedures.

  • Must demonstrate thorough understanding of all provider network requirements, including but not limited to credentialing and accreditation, network participation, complex reimbursement methodologies, contract performance measures, PLAN quality initiatives, BCBSA initiatives, and corporate initiatives.

  • Demonstrates strong organizational, analytical and project management skills.

  • Must demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.

  • Regularly reviews PLAN provider data to identify “trends” and gaps in provider network activity.

  • Conducts periodic meetings with provider account representatives to maintain network adequacy requirements.

  • Must maintain confidentiality of PLAN information.

  • Engages providers in participation of applicable corporate initiatives to ensure appropriate audiences are informed accurately and timely.

  • Maintains current knowledge of URAC accreditation requirements for Network to help obtain or exceed departmental, divisional and/or company goals.

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.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

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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