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Blue Cross and Blue Shield Association - Des Moines, IA

posted 20 days ago

Des Moines, IA
Religious, Grantmaking, Civic, Professional, and Similar Organizations

About the position

As a Provider Network Contract Manager, you will drive initiatives that support the development, innovation and maintenance of Wellmark's Health Care Network Contracting strategy for Commercial and Government programs. You will take the lead on building and maintaining relationships with health care organizations and network providers to aid in successful development and negotiation of contracts. You won't do it alone though. You will collaborate with internal stakeholders to gather data and insights to aid in this work. You will also provide input for decisions related to the composition of Wellmark's health care provider networks to develop new provider networks and strategies.

Responsibilities

  • Work cross-functionally to help develop and execute Wellmark's and/or BCBSA's network strategies. Maintain accountability for specific contract initiatives.
  • Analyze data to design and recommend provider contract methodology strategies and provider specific strategies.
  • Analyze data to design and recommend contract amendments. Perform network analysis, strategy development and implementation; obtain data, verify validity, and analyze network availability/access for contracting opportunities.
  • Work collaboratively with contract team and HCI leadership regarding provider contracting requirements and to draft new provider contracts and amendments to existing provider contracts.
  • Build and maintain relationships with providers by communicating regularly with providers regarding contract initiatives and new contract opportunities. Provide responses to inquiries regarding Wellmark's contracts.
  • Support division wide communications with the coordination of internal messaging of provider contracting initiatives.
  • Create unique agreements/amendments related to payment or special benefits for an employer, i.e., high performance network, tiered networks, carve-out benefits, etc.
  • Assist with any contract research for audit, compliance, and contract management, etc.
  • Complete network adequacy reviews and QHP template annually for all required networks.
  • Assist Legal and/or compliance with Insurance Division provider network inquiries and E&O application.
  • Other duties as assigned.

Requirements

  • Bachelor's degree or direct and applicable work experience.
  • 4+ years of managed care, health care provider negotiation or contracting related experience.
  • Knowledge of contracting strategies, provider reimbursement methodologies, contract administration, setup, and maintenance.
  • Understanding of compliance and adequacy requirements.
  • Strong negotiation, influence, and relationship management skills.
  • Strong written and verbal communications skills with the ability to share recommendations with varying audiences, including providers.
  • Strong analytical and critical thinking skills.
  • Proactive self-starter with effective time management and prioritization skills.
  • Proficiency with Microsoft Office, such as Word, PowerPoint or Excel, and other applications.
  • Ability to travel.

Nice-to-haves

  • Bachelor's degree.
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