Blue Cross and Blue Shield of Louisiana Senior Provider Contract Negotiator in Baton Rouge, Louisiana
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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.
Serves as the Plan 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 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: Director, Provider Contract Negotiations
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 Provider Network 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.
Bachelor's degree in Business, Healthcare or in a related field is required
Four years of related experience can be used in lieu of a Bachelor’s degree.
4 years of experience in the health care industry focusing on the establishment and maintenance of hospital and facility managed care contractual agreements, face-to-face interaction and business relationships with providers in a managed care setting and managed care hospital and facility contracting experience is required
Prior value based contracting experience is required
Experience negotiating multi-provider contracts with hospital systems and negotiating value based reimbursement contracts is required
Skills and Abilities
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.
Must fully 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.
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 and manage hospital/facility contract negotiations and resolve problems with tact and diplomacy.
Must have ability to prioritize and handle multiple competing responsibilities 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. Firsthand knowledge and experience with the Emptoris Contract Management System is preferred.
Must have ability to travel for provider on-site visits, association meetings, presentations, etc.
Must have dependable transportation and be willing to travel frequently throughout the state as necessary.
Licenses and Certifications
- None Required
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Builds effective provider networks by independently negotiating fee for service and value based contractual language and competitive reimbursement with all provider types that pose a mid to high level degree of difficulty to ensure consistency with corporate goals and budget.
Independently 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 with difficult problems that they are unable to resolve through normal/available channels, participating in the dispute resolution process for providers in assigned territory according to Network Policy and Procedure, participating as appropriate for in-services and workshops, engaging providers to participate in BCBSLA initiatives and meets with network providers on a regular basis or as needed, to maintain provider satisfaction.
Mentors less experienced Network Development Representatives 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.
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.
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