Network Manager II
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Job Description
Network Manager strengthening Tennessee provider networks for BlueCross BlueShield of Tennessee. Managing provider relations, contracting, reimbursement analysis, compliance, and network performance.
Responsibilities:
- Identify educational topics, methods, and strategies to enhance compliance throughout the provider network
- Implement, support, and monitor provider programs and enterprise initiatives
- Implement processes and changes to maintain regulatory and contract compliance and improve quality
- Handle escalated provider enrollment processing and problem resolution
- Lead data reporting and analysis projects monitoring financial and service relations with providers
- Consult with providers on delivery, training, and support issues
- Identify opportunities for enhancement and recommend solutions
- Travel to provider offices or conduct virtual meetings as required
- Support and strengthen provider networks across Tennessee
- Assist with contract negotiations and resolve complex provider issues
- Analyze reimbursement impacts and collaborate with internal teams to improve provider experience and network performance
Requirements:
- Bachelor's degree in business, healthcare, or a relevant field, or equivalent work experience required
- 3 years of experience in provider relations and network development, emphasizing healthcare education and reimbursement
- Ability to speak publicly and conduct effective presentations
- Ability to work independently with minimal supervision or in a team environment
- Ability to interpret and translate technical and complex concepts into meaningful information
- Proficiency in Microsoft Office, including 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, self-driven, engaging, proactive, and results-driven attitude
- Knowledge of medical terminology
- Knowledge of contract language, reimbursement methodologies, managed care business processes, case-mix adjustment, utilization management, and applications for claims payment
- Valid driver's license
- Maintaining auto insurance compliance and an acceptable motor vehicle record when routinely driving for company business
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