Mgr- Provider Network Operations
Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.
Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Internal use only-grade 30-32
Manages the day-to-day activities related to Network Operations including compliance with service levels and
mandated requirements. Serves as the primary contact and resource for the staff. Provides oversight, direction,
development, problem resolution and leadership for team. Ensure operational and department goals are achieved as
assigned. Improve quality and business processes for assigned area of
1. Required Work Experience
· 3 years of experience in management field
* 3 years of experience in direct customer service
* 1 year of experience managing production
2. Required Education
* High-School Diploma or GED in general field of
3. Required Licenses
4. Required Certifications
1. Preferred Work Experience
· 5 years of experience in a management role in provider network operations
2. Preferred Education
· Bachelor's Degree in general field of
3. Preferred Licenses
4. Preferred Certifications · Certified Healthcare Financial Professional · Certified in credentialing or medical staff services including CPCS or CPMSM
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
* Manage the day-to-day activities of a team of employees engaged in provider network operations functions. * Direct, evaluate, define and improve the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines. * Administer, interpret and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals as related to the assigned area of responsibility. * Keep team informed of new or updated service standards, systems, procedures, forms and manuals through staff meetings and verbal and written communications. * Responsible for the review, update and accuracy of department documentation, computer files, policies and procedures related to the department goals and objectives. * Interview, hire, train, supervise and evaluate department staff. * Maintain current and thorough understanding of credentialing standards and requirements to ensure the credentialing / recredentialing operational process is in alignment with those requirements * Ensure compliance with state and federal law regarding new provider credentialing and loading including mandated turnaround times and credentialing requirements * Assure provider files contain required documentation on an ongoing basis and comply with audit requirements * Consult and coordinate with various internal departments, external Blue Plans or business partners, providers, business entities, and government agencies as a representative of the area of responsibility. * Provide support for providers and Plan including excellent customer service skills in interactions with Providers, Provider Partnership staff, Legal staff, Medical Directors and HealthCare Quality Assurance leadership. * Identify department needs relating to computer file update / automation to maximize effective use, evaluating software applications and/or participating in application development.
* Monitor and investigate computer system issues.
* The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements. * Perform all other duties as assigned.
1. Required Job Skills
· Intermediate skill in use of office equipment including copier, fax machine, scanner and telephones
· Intermediate PC proficiency
· Intermediate skill in word processing, spreadsheet and database software
2. Required Professional Competencies
· Maintain confidentiality and privacy
· Analytical knowledge necessary to review reports and then make decisions based on reported data
· Practice interpersonal and active listening to achieve customer satisfaction and departmental communication
· Establish and maintain working relationships in a collaborative team environment
3. Required Leadership Experience and Competencies
· Make use of employees’ skills and abilities to deliver business objectives
· Use available information to focus the team’s activities and identify
1. Preferred Job Skills
· Knowledge of NCQA, URAC and JCAHO credential requirements
· Understanding of workflow systems to maximize resources and streamline processes for
2. Preferred Professional Competencies
3. Preferred Leadership Experience and Competencies
Comply with BCBSAZ corporate and departmental policies and procedures, including, but not li
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.
Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross® BlueShield® of Arizona