Job Description

Awarded the Best Place to Work 2021, 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.

This remote work opportunity requires residency, and work to be performed, within the State of Arizona.

Negotiates and contracts with healthcare providers (hospitals, physicians, etc.) and manages the day-to-day activities related to Network Administration and Network Relations of the provider network(s). Serves as the primary provider contracting contact and resource for the staff.  Provides oversight, direction, development, problem resolution and leadership for all contracting activities for the team. Ensure contracting, department goals are achieved as assigned, improve quality and business processes for assigned area of responsibility.

REQUIRED QUALIFICATIONS

Required Work Experience

  • 5 years of experience in healthcare or related field.

Required Education

  • High-School Diploma or GED in general field of study

Required Licenses

  • Valid Arizona Driver License with an acceptable driving record

Required Certifications

  • N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

  • 8 year(s) of experience  managing provider and customer relations including negotiations and complex project management

Preferred Education

  • Bachelor's Degree in business, finance, or other field of study
  • Legal training, including Juris Doctorate or Paralegal experience

Preferred Licenses

  • N/A

Preferred Certifications

  • Certified Healthcare Financial Professional

ESSENTIAL job functions AND RESPONSIBILITIES

  • Manage the day-to-day activities of hospital and provider contracting, including complex contract reviews, drafting of contract amendments and management of contracts.
  • Using strong negotiation skills, contract with healthcare providers to meet targeted goals.
  • Accurately represents the core values of Blue Cross Blue Shield to outside entities.
  • Understand and interpret various analyses of the financial structure of contracts to ensure it meets financial targets.
  • Direct, evaluate, define, and improve the quality, quantity, and timeliness standards to achieve individual and department performance goals as defined within the department guidelines for provider contracting.
  • Administer, interpret, and maintain current working knowledge of the required BCBSAZ contracting systems, procedures, forms, and manuals as related to the assigned area of responsibility.
  • Keep team informed of new or updated contracting methodologies, contract languages, and contracting 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.
  • 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.
  • Identify, research, process, resolve and respond to provider inquiries and correspondence via telephone, written communication and/or in person.
  • Serve as a team leader, facilitator, or team member of the quality management process when requested.
  • 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.

competencies

REQUIRED COMPETENCIES

Required Job Skills

  • Intermediate skill in use of office equipment including copies, fax machine, scanner, and telephones
  • Intermediate PC proficiency
  • Intermediate proficiency with word processing, spreadsheet, and database software

Required Professional Competencies

  • Proven track record of negotiating difficult contracts and agreements to meet targeted goals.
  • Strong ability to understand and interpret financial data and analyses.
  • Ability to maintain confidentiality and privacy of data.
  • Ability to plan, organize and manage the work of all assigned personnel.
  • Proven leadership and management skills.
  • Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data
  • Capable of investigative and analytical research
  • Compose and dictate a variety of business correspondence
  • Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards
  • Establish and maintain working relationships in a collaborative team environment  
  • Ability to plan, organize and manage the work of all assigned personnel

Required Leadership Experience and Competencies

  • Make use of employees' skills and abilities to deliver business objectives
  • Use available information to focus activities, identify priorities and strengthen team effectiveness    

PREFERRED COMPETENCIES

Preferred Job Skills

  • Ability to speak, write and communicate effectively and professionally
  • Ability to establish and maintain personal relationships with the public and professional elements, to include community and professional groups, which reflect favorably for the department and BCBSAZ

Preferred Professional Competencies

  • Knowledge of various provider reimbursement methodologies including capitation, gain sharing, etc.
  • Knowledge of contract structures, language, and the ability to interpret complex contracts and legal documents
  • Knowledge of a wide range of principles and methods pertaining to the department's service and operations
  • Knowledge of State, Federal, and other regulatory requirements as they apply to assigned area of responsibility
  • Ability to coordinate activities of several different departments to resolve issues

Preferred Leadership Experience and Competencies

  • Ability to optimize resources to ensure a cost effective operation. Includes proactively planning to move staff from one role to another as staffing needs change, business priorities change or as workload change requires.
  • Ability to participate in the development of strategic plans as needed
  • Ability to implement new processes and procedures

Our Commitment

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.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online