Please email [email protected] if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

Location: Hybrid
Compensation: $63,000 - $94,400

Jump into the new world of health insurance:

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.

Join others who know diversity is strength:

We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.

Why this job matters:

Negotiate, implement, and manage complex contracts with healthcare providers and vendors. Work to achieve the organization's financial and business objectives, impacting network quality and trends via thoughtfully structured contractual relationships.

What you will do:

• Deliver a broad, quality focused, stable, and high-performing network to support the BCBSRI customer base.
• Develop and execute negotiation strategies that directly impact financial and quality performance of the network consistent with corporate objectives. Leverage deep financial views into and understanding of quality and trend performance.
• Accountable for development and management activities with various provider types and vendors.
• Ensure provider agreements comply with BCBSRI policies, business standards and regulatory guidelines.
• Build and maintain strong, respectful professional relationships with providers, vendors, internal staff and members of BCBSRI leadership team.
• Perform and monitor activities related to the contract implementation and load process; engage appropriate organizational units for claims resolution; provider service/performance issues; and provider and member appeals.
• Proactively provide guidance/recommendations to organizational Leadership regarding healthcare costs and benchmarks, trend impact opportunities as well as provider quality opportunities.
• Maintain highest personal/professional integrity and enforce principles of integrity and compliance.
• Perform special projects as assigned, which may include work on internal and/or external committees or task forces. Interpret, educate, recommend, and communicate information effectively as a representative of BCBSRI and the division.
• Participate in department initiatives and projects.
• Perform other duties as assigned.

What you need to succeed:

• Bachelors degree in business, healthcare management, or related field required or an equivalent combination of education and work experience
• Three to five years' experience in network development and contract management role, negotiating healthcare contracts with providers and/or vendors
• In-depth understanding of provider delivery models, provider financing as well as health plan operations and financing
• Highly proficient in developing, interpreting, and utilizing provider financial and quality data
• Strong knowledge of provider reimbursement as well as pay for performance models
• Solid understanding of provider billing/claims processing practices, coding standards as well as industry standard payment and medical policies
• Advanced analytical skills, with the ability to interpret and synthesize complex data sets
• Good business acumen and political savvy
• Knowledge of business process improvement techniques and strategies
• Excellent verbal and written communications skills
• Negotiation skills
• Presentation skills
• Decision-making skills
• Good problem-solving skills
• Ability to interface with employees at all levels
• Ability to effectively navigate ambiguous situations with limited direction
• Excellent organizational skills and ability to successfully prioritize multiple tasks
• Ability to handle multiple priorities/projects

Extras:

• Masters degree in business or Healthcare Administration

Location:

BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.
The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit https://www.eeoc.gov/employers/eeo-law-poster to view the "EEO is the Law" poster.

Other details

• Pay Type Salary

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