Behavioral Health Network Manager II

Maintains relationships with providers by daily interaction and delivers technical assistance to correct any errors and control risks for the insurer and provider.

Job Description:

Job Responsibilities

• Identifying educational topics, methods, and strategies to enhance compliance throughout the provider network.
• Implementing, supporting, and monitoring provider programs and enterprise initiatives
• Implementing processes and changes needed to maintain regulatory compliance, contract compliance or to improve quality.
• Handling escalated provider enrollment processing and problem resolution.
• Leading data reporting and analysis projects to monitor financial and service relations with providers.
• Consulting with providers on delivery, training and support related issues, identifying opportunities for enhancement and recommending solutions.
• Able to travel to provider offices or conduct virtual meetings as required.

Job Qualifications

Education

• Bachelors degree in business or healthcare or relevant field or equivalent work experience required

Experience

• 3 years - Experience in provider relations and network development with emphasis on healthcare education and reimbursement.

Skills\Certifications

• Ability to speak in public and conduct effective presentations.
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Demonstrated ability to interpret and translate technical and/or or complex concepts into information meaningful to project team members and/or business personnel.
• Proficient in Microsoft Office (Outlook, Word, Excel, Access and PowerPoint)
• Accuracy and attention to detail
• Effective time management skills
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Strong analytical skills
• Ability to manage multiple projects and priorities
• Positive attitude, self-driven, engaging, proactive, results drive
• Knowledge in Medical terminology
• Knowledge of contract language and reimbursement methodologies, managed care business processes, case-mix adjustment, medical terminology, utilization management and applications for claims payment, required.

License

• Valid Driver's License

Job Specific Requirements: 

Behavioral Health experience highly preferred

Health Insurance Payor experience is preferred.

Medicaid experience is preferred.

Provider Relations experience highly preferred.

Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program.   The employee will also be required to adhere to the guidelines set forth through the program.  This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).
*The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.

Preferred Skills:

Number of Openings Available:

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

Remote-First Statement:

BCBST is a remote-first organization with many employees working primarily from their homes.  Each position within the company is classified as either fully remote, partially remote, or office based.

BCBST hires employees for remote positions from across the U.S. with the exception of the following states:  California, Massachusetts, New Hampshire, New Jersey, and New York.  Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense.  If the applicant moves to Chattanooga, TN, they may be eligible for relocation benefits.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

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