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

REQUIRED QUALIFICATIONS:

• Bachelor’s degree in business administration, accounting or a related field. Four years of related experience can be used in lieu of a bachelor’s degree.
• 7 years of leadership experience in healthcare or related environment.
• 5 years of operations management experience in healthcare or related environment.
• 3 years of experience in negotiations and executing contracts in payer and/or provider organizations, including leading complex contract negotiations.
• Experience can run concurrently.
• Must be an expert negotiator with industry knowledge.
• Must have strong interpersonal skills with external contacts, internal Plan staff as well as with the department staff within the Provider Networks & Contracting Department.
• Must have strong financial acumen and a comprehensive understanding of contractual options and healthcare economics.
• Must have strong legal knowledge base to facilitate communication with payer and provider legal teams.
• Excellent command and proven experience with critical face-to-face communication and presentation skills are required.
• Must have a keen understanding of competitive factors in the market place and current demands that can affect negotiation outcomes with providers.
• Must have experience writing, editing, and developing complex contractual documents.
• Residing in or around Baton Rouge, La is required.
• Frequent travel in and around the state required.

PREFERRED QUALIFICATIONS:

• Master’s Degree in Health Care Administration, Business Administration or a related field.

JOB SUMMARY/POSITION PURPOSE:

This position will provide overall leadership and management for Provider Networks and Contracting activities. Will be charged with establishing and overseeing all aspects of the corporate provider network management functions including provider negotiations, provider contracting, network development, and provider contract management.

HOW YOU CONTRIBUTE TO THE COMPANY’S MISSION IN THIS ROLE:

• Ensures that provider networks support the Plan’s product portfolio and provide the appropriate level of access and reimbursement so that the Plan’s products are competitive.
• Works cross functionally to develop network strategies, articulate risk arrangements and monitor network and contracting functions to support the strategic direction of the company, achieve corporate goals and create significant, incremental value for members, customers, and providers.
• Develops, leads, and aligns the execution of both short-term tactical initiatives and long-term strategies which will facilitate the organization’s ability to meet or exceed operating annual medical cost budgets and Medical Loss Ratio (MLR) targets.
• Develops the necessary programs and services to guarantee a high level of provider satisfaction and corporate efficiencies related to provider network management and electronic claims and inquiries.
• Manages budgeting and forecasting initiatives for network costs and provider contracts.
• Uses analysis based on claim trend data and/or market information to derive conclusions to support contract negotiations.
• Conducts regular review of provider contracting rates and network design.
• Integrates with the reimbursement staff and assures contracting processes are current and consistent with new payment methodologies.

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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