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Job Profile

Director Provider Contracting

Omaha, NE
Posted 11/18/20

Job Description

Blue Cross and Blue Shield of Nebraska (BCBSNE) is more than just an insurance company; we exist to be there for people in the best and hardest moments of their lives.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it!

As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

This position is responsible for developing, negotiating and completing contracts with all provider types, as well as participating in the strategy vision and administration for network development and management.  This position is responsible for negotiating and executing case specific out-of-network exceptions for BCBSNE members who utilize providers who are not participating in a Blue Cross Blue Shield provider network. The Director works with the Legal Department in resolving contractual questions and with several other cross-functional areas for provider questions and issues. This position builds relationships with and serves as the lead negotiator with physicians and hospitals across Nebraska in support of the provider network strategy of BCBS Nebraska. This position reports to, and works in partnership with the VP Health Network Services.

What you'll do:

  • Develop and make recommendations to the VP of Health Network Services and EVP Health Delivery Engagement and execute negotiation strategies that directly impact the financial performance of BCBSNE.
  • Work with the HDE and analytics teams to develop strategies to achieve unit cost targets and implement value based care agreements. Monitor competitiveness of market discounts and correct areas where BCBSNE is disadvantaged vs. the competition.
  • Evaluate and enhance the provider contacting process. Implement efficiency opportunities and evaluate contracts for enhancements that bring value to BCSBNE customers. Oversee the provider contracting process.
  • Advise and guide senior management regarding health care costs, cost savings opportunities, best practices, provider performance issues, and network expansion.
  • Lead and facilitate contract negotiations with hospitals, doctors and other provider groups for all lines of business, including Medicare Advantage. Contact and negotiate out-of-network exceptions with out-of-network providers utilized by BCBSNE members. Negotiate with providers to enhance availability of health care services for BCBSNE members and support new products included in provider networks. Work with Legal Department and other areas to respond to provider contract issues and complaints.
  • Provide leadership to the provider contracting team.

To be considered for this position, you must have:

  • Bachelor's degree in a related field and 5 years of experience in provider contracting and provider network administration.
  • 5 years experience of management and leadership.
  • Experience in collaborating with multiple departments and all levels of management. The ability to meet communicated schedules and deadlines.
  • The ability to meet or exceed the attendance and timeliness requirements of their departments.
  • The ability to work well in a team environment, and be capable of building and maintaining positive relationships with other staff, departments, and customers.

The strongest candidates will also possess:

  • Health Insurance experience
  • 10 years of experience in provider contracting and provider network administration.

 

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans

 

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