Provider Contracting Manager

Summary
 As a Provider Contract Manager, you will establish and maintain provider networks for assigned lines of business. You will serve as main contact for all recruiting or recontracting efforts and all contract questions or issues that arise with providers. You will also recommend and implement cost-effective strategies while delivering high quality products to customers.
Description
 

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Logistics:

This position is onsite at 4101 Percival Rd. Columbia, SC 29229. The hours are 8:00 a.m. – 5:00 p.m. Monday – Friday.

What You'll Do:

• Develop and manage relationship with providers.
• Conduct initial/renewal contract negotiations with providers.
• Perform detailed financial analysis and modeling of provider contract proposals to determine financial impact of various pricing/contract decisions.
• Influence provider behavior by means of education, utilization analysis and presentation of provider performance.
• Ensure contract obligations are met.
• Direct/coordinate credentialing process for provider networks.
• Monitor performance to ensure contract compliance by internal departments and medical providers.
• Review/audit data compiled by subcontractors in accordance with the Center for Medicare and Medicaid services (CMS) regulations.
• Assist with impact analysis of pricing decisions regarding negotiated payment rates for network providers.
• Develop/maintain effective working relationships with providers, government agencies, internal departments, and other customers.
• Ensure responses are given in a timely manner to all inquiries.
• Maintain working knowledge of current and proposed regulations of state and federal laws and the latest trends in healthcare technology and financing. Evaluate and communicate any pertinent changes to management.
• Assist in the development of training programs and materials for internal staff. Participate in special projects to improve external and internal processes.

To Qualify for This Position, You'll Need:

• Bachelor's Degree required.
• 5 years of relevant financial/administrative experience in an insurance, managed care or healthcare related setting that may include provider relations, managed care contracting, provider operations, or provider billing, etc.
• Ability to develop/maintain effective business relationships with providers, and representatives.
• Excellent verbal and written communication skills.
• Excellent presentation and project management skills.
• Excellent analytical and critical thinking skills.
• Ability to handle confidential or sensitive information with discretion. Demonstrated knowledge of managed care contract negotiations.
• Experience with Microsoft Office.
• Working knowledge of reimbursement systems.

What We Prefer:

• Bachelor's degree-in Healthcare Administration, Business Administration, Nursing, or other job-related field.
• 8 years of relevant financial experience in a healthcare setting that may include provider relations, provider contracting, provider operations, or provider billing, etc.
• General knowledge of provider billing/accounting systems including electronic claims filing.
   

What We can Do for You:

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave – the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.
• Incentive Plan.
• Merit Plan.
• Continuing education funds for additional certifications and certification renewal.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications.  This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.