Resp & Qualifications

We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.

PURPOSE: 
Responsible for the daily management, coaching, and development of the Provider Relations team including oversight of department operations, promoting quality service, strengthening relationships through proactive training, education, communication, and ensuring complex problem resolution to all network providers in Maryland, DC, Northern Virginia and continuous counties.

ESSENTIAL FUNCTIONS:

• Responsible for improving provider experience; anticipates provider issues and develops a plan to reduce concerns through better alternatives; responsible for issue resolution and escalation as appropriate; sets goals for and work closely with the team to drive performance to ensure provider experience metrics are met or exceeded
• Provides direction and guidance to staff to explain and coordinate administrative process and needs; coaches and trains direct reports to ensure a competent and effective workforce with the necessary skills and competencies to provide quality service to both internal and external customers & performs all management duties including hiring, goal setting and monitoring, performance review, budget review, coaching and development of associates, one-on-one meeting, conflict resolution, etc.
• Implements ongoing provider education initiatives within area of accountability; seeks to proactively improve level of education over time
• Responsible for representing Networks Management/Provider Relations in a variety of work groups to support divisional and corporate level initiatives.
• Collaborates with a variety of stakeholders within and outside of the division by managing key initiatives and projects; builds and maintains a solid professional relationship with key personnel representing provider from office worker to managed care executive & manages relationships with external associations including medical societies, Maryland Hospital Association (MHA), American Association of Hospital Administrator Management (AHAM), medical specialty associations, etc.

SUPERVISORY RESPONSIBILITY:
This position manages people.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Business or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 5 years experience in healthcare claims and/or service experience. 1 year supervisory experience or demonstrated progressive leadership experience.

Preferred Qualifications:

• Advanced degree as evidenced by MBA & knowledge of CareFirst provider relations systems, processes and contracts.
• Experience working with healthcare providers, ideally in a payer setting.

Knowledge, Skills and Abilities (KSAs)

• Strong interpersonal skills. Ability to work independently, as well as a member of a team.
• Strong critical reasoning skills in clinical decision-making, planning and organizing.
• Working knowledge of provider community, provider reimbursement, medical terminology, CPT coding and CMS 1500 or CMS 04.
• Ability to determine priorities and meet deadlines.
• Strong customer service skills.
• Proven effective written and interpersonal communication skills, well organized, ability to multi-task and work independently, promote flexibility and teamwork Strong PC skills with experience using Microsoft Office applications.
• Strong problem-solving ability, critical thinking, and analytical skills.
• Ability to train and mentor staff.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $92,320 - $171,369

Travel Requirements
Estimate Amount: 30% In normal environment, expected to regularly meet with providers in person at their practice or other central location

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Provider Relations and Education

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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