Summary
Position Purpose:
As a Provider Data and Network Management Manager, you will be responsible for management/maintenance of provider systems within private business. You will ensure networks, provider designations, and benefit applications are monitored to be in compliance with our corporate contractual obligations. Demonstrating your leadership skills, you will lead corporate projects involving provider systems to ensure changes are managed/integrated within claims system appropriately and be responsible for supplying accurate information used in provider contracting, managed care services.

This position is responsible for oversight of National Alliance Partner Plan Provider Data Maintenance, including tiered networks and provider Directories. Building and maintaining positive relationships with National Alliance Marketing, Management and other team members is a crucial aspect of this management position. This role is also responsible for BlueCross BlueShield Association Provider Data Inquiries, Provider File submission issues resolution, Provider Data related Surveys and primary contact for Operations related Provider Data information.

Logistics:
***At management\'s discretion, work from home after the training period. ***
Work hours are Monday through Friday from 8 a.m. to 4:30 p.m.

Description

What You\'ll Do:

• Develop and maintain corporate provider file to include managing system updates required along with the integration of the system into AMMS. Resolve problems related to network agreements, provider data integrity, and benefit files coordination based on provider classifications and benefit structures.
• Manage network participation to include oversight of the networks within PIMS (preferred blue, state health plan, Medicare advantage) and produce directories to meet line of business needs. Identify and execute changes to improve efficiency and timeliness of provider data entry.
• Select, train/guide, and manage staff. Ensure excellent customer service is given to internal employees/customers, business units, and external customers. Prepare, monitor, and analyze cost center expenditures.
• Manage/review reporting to ensure the file is updated correctly and claims are being processed based on network and provider classifications as indicated in benefit contracts with our customers. Produce and/or review reports necessary to support the contracting and managed care functions. Ensure quality reviews are completed to ensure compliance and minimize claims errors due to incorrect file updates.
• Develop and support tiered member accounts by working with business leaders in determining best approaches for supporting new groups. Work with different member groups to understand needs.
• Support BCBSSC\xe2\x80\x99s initiative with BlueCross BlueShield Association for improvements and support new requirements as it relates to provider data processing and development of member transparency tools.

To Qualify for This Position, You\'ll Need:

• Bachelor\'s degree in Accounting, Business Administration, Computer Science, Nursing, or other job-related field, OR four (4) years of job-related work experience.
• Five (5) years of provider network, business office, or provider/insurance experience, including either two (2) years of supervisory experience OR two (2) years of equivalent military experience in grade E4 or above.
• Strong knowledge of word processing, spreadsheet and database software.
• Excellent oral and written communication skills.
• Excellent organizational, customer service and presentation skills.
• Excellent analytical or critical-thinking skills.
• Excellent problem-solving skills.
• Proficiency in spelling, grammar, punctuation and basic business math.
• Ability to persuade, negotiate with and influence others.
• Ability to handle confidential or sensitive information with discretion.
• Ability to listen effectively and respond quickly.
• Microsoft Office experience including Excel.
• Strong knowledge of Microsoft Access, EasyTrieve, DB2, or other database software.

Work Environment:
Typical office environment.
Travel as required.

What Blue Can Do For You:
Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match
• Subsidized health plans and free vision coverage
• Life insurance
• Paid annual leave \xe2\x80\x94 the longer you work here, the more you earn
• Nine paid holidays
• On-site cafeterias and fitness centers in major locations
• Wellness programs and a healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• And much more!

What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you 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 those candidates who qualify, with prioritization given 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.

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 abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.