at Blue Cross Blue Shield of Kansas in Topeka, Kansas, United States
Job Description
Under the direction of the Director, Provider Network Solutions Operations, position is responsible for divisional operations activities for the BCBSKS provider networks including enrollment, procedural and record quality initiatives, record maintenance, and provider communications. Designs, implements and monitors procedures to ensure smooth, accurate and timely workflow within the department and works collaboratively across BCBSKS to ensure provider network processes and activities are transparent, and adhere to internal and external audit and compliance requirements. Manage the work of Provider Network Solutions team members ensuring onboarding and network maintenance activities frame a compliant, quality driven provider network to strengthen BCBSKS provider experience and member's access to our provider network. Provide timely education to department team members. Manage department activities in support of meeting corporate goals and objectives. Ensures the accuracy and timeliness of provider data for directory purposes.** This position is eligible to work hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.
Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.
Why Join Us?
- Lead and Inspire: Guide and mentor your team to achieve their full potential and success.
- Family Comes First: Total rewards package that promotes the idea of family first for all employees.
- Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
- Trust: Work for one of the most trusted companies in Kansas
- Stability: 80 years of commitment, compassion and community
Compensation
116,000 - $145,000
Exempt grade 18
- Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The salary range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive salaries that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.
What you'll do
- Directs the coordination of activities related to provider contracting and network enrollment. Includes workflow review and assignment, network onboarding activities including contract initiation, record creation and maintenance.
- Establishes goals and objectives supporting the management and supervision the daily activities of the department ensuring alignment with corporate goals and objectives.
- Collaborates with other departments/divisions to attain accurate and up-to-date information for provider network framework requirements, expectations, adequacy, adherence, and experience.
- Responsible for the coordination and general direction of provider network communications to include contracting documents, provider memos, policy updates, network initiatives, etc.
- Identifies problems and designs/recommends team member success needs through guidance and coaching.
- Ensure compliance of all requirements by law for establishing new provider data, as well as maintenance, and storage.
- Identifies, designs, and implements appropriate solutions to staffing, quality and workload problems in a timely and effective manner. Interview, hire, and discipline.
- Provides appropriate and timely performance feedback to staff both formally and informally. Reviews and recommends merit and promotion increases.
- Anticipates the impact of the changing healthcare environment on assigned work areas and adjusts work assignments and processes as necessary to maintain quality and efficient workflow within the department.
- Manages assigned projects meeting deadlines and assuring results meet the business need of the organization.
- Responsible for the creation, updates, and publishing of all Provider Network Solutions policies and procedures for both internal transparency and guidance and external accreditation compliance standards.
- Direct oversight of Supervisor, Provider Network Enrollment and Supervisor, Provider Network Records and Quality. Indirect supervision of assigned team members to each supervisor.
Knowledge/Skills/Abilities
- Excellent organizational and administrative application skills
- Advanced supervisory history demonstrative of coaching success, design of goals and human relations
- Excellent Written and Verbal Communications
- Broad knowledge of health industry as it relates to professional and institution provider operations
- Independent problem solving and analytical skills
- Leadership skills focused on strategic review and positioning, problem solving, mediation, and process improvements
- Ability to communicate effectively, both orally and in writing
- Ability to develop and present educational programs and/or workshops
- Ability to direct the development of programs/processes related to compliance with external and accreditation standards and requirements
- Strengths in collaboration and foster effective working relationships to build consensus
- Budget oversight and adherence
What you need
- High school diploma or equivalent required. Bachelor's degree with emphasis in general business, communications, or human relations preferred
- Minimum of 5 years' experience in health care industry required.
- Experience in development and maintenance of provider networks, knowledge of contracting processes, health plan compliance and accreditation standards required.
- Three years proven supervisory/management experience required.
Physical Requirements
- Position will be PC work up to 90% of time inclusive of online meeting attendance.
- For onsite position assignment, sit / stand desk is available.
- Position is onsite/situational, requiring onsite attendance a minimum of 3 days each week.
- Must be able to travel as requested.
- Phone, electronic, virtual and/or in-person coaching or training will be necessary up to 50% of work week.
- Minimal lifting, up to 15 pounds relative to any printed procedure or training manuals.
Benefits & Perks
- Base compensation is only one component of your competitive Total Rewards package
- Incentive pay program (EPIP)
- Health/Vision/Dental insurance
- 6 weeks paid parental leave for new mothers and fathers
- Fertility/Adoption assistance
- 2 weeks paid caregiver leave
- 5% 401(k) plan matching
- Tuition reimbursement
- Health & fitness benefits, discounts and resources
Our Commitment to Connection and Belonging
At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.
Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment. To view full details and how to apply, please login or create a Job Seeker account
