Job Description
We are seeking a dynamic leader to drive excellence in provider, member, and business partner interactions while fostering strong, productive relationships. This role partners with stakeholder leadership to shape business strategies that support operational efficiency and deliver an exceptional member experience.What You’ll Do
People Management
Develop performance goals and track performance against established goals. Handle complex employee issues.
Conduct random audits of teams work.
Review audit results with staff and create performance improvement plans as necessary.
Develop and implement training plans to ensure growth and development for staff.
Develop staff provider relation skills and provider communication through formal and informal training, coaching, and feedback.
Interpret and analyze complex data from staffing models and other sources to identify issues and make recommendations for effective solutions.
Develop resource allocation strategies to meet changing business demands.
Stakeholder Engagement
Represent BCBSNC in stakeholder meetings to address stakeholder inefficiencies and to ensure contractual compliance.
Plan all on-site visits to stakeholders to educate on BCBSNC medical or administrative policies and procedures.
Address stakeholder concerns and non-compliance contract/administrative issues. Coordinate the required corrective actions.
Partner with assigned stakeholders to understand their processes, procedures and systems as they relate to the way they conduct business with BCBSNC.
Develop and maintain extensive knowledge of key stakeholders and/or regional territories.
Leverage knowledge base to forward Enterprise relationships with stakeholders.
Track stakeholder issues for root-cause analysis, escalation, and closure.
Document issue resolution using issue resolution protocol.
Comply with state, federal and BCBSA regulations governing stakeholders and suggests implementation of any product, process, or system modifications to ensure compliance.
Identify opportunities to control medical expense and deploy action plans to accomplish stakeholder-specific or regional medical expense goals.
Participate in negotiations with stakeholders as needed.
Project/Program and Operations Support
Manage day-to-day consultative activities for a high-profile healthcare system.
Participate in and support negotiations as needed.
Assist in the analysis of all products, identify any deficiencies and make recommendations for improvement.
Provide analysis and feedback for technologies, trends, best practices and service offerings to incorporate them into overall stakeholder business solutions.
Lead team of onsite coordinators in identifying, analyzing, and resolving complex operational issues impacting the healthcare system.
Act as technical resource for the team providing assistance on system issues, work processes, and procedures.
Represent the department on corporate projects that require independent, sound decision making and broad-based understanding of the effects on the department as a whole.
Develop and recommend short- and long-term service objectives and methods, implement these methods when approved.
Respond quickly and accurately to escalated issues from clients and customers. Review customer needs and delivery commitments and review with team members.
Identify, analyze and resolve complex high dollar operational issues impacting the healthcare system they are responsible for or the members and groups that they serve. Use the appropriate Stakeholder Service Model to increase customer satisfaction and reduce administrative costs.
What You Bring
Bachelor's degree or advanced degree (where required)
8+ years of experience in related field.
In lieu of degree, 10+ years of experience in related field
LEAN certification advanced within 12 months of hire.
Bonus Points
Experience in provider interactions with institutional, professional and ancillary providers.
Experience in claims, customer service, membership, enrollment or a call center environment.
Experience managing a project
Ability to interpret policy provisions
Make sound and independent business decisions in high pressure situations
Excellent interpersonal and relationship building skills
Strong data analysis and problem-solving skills
Knowledge of institutional and ancillary pricing, health care finance, hospital and ancillary payments
Strong negotiation skills
Ability to effectively manage multiple high priority and high-profile tasks/provider relationships
What You’ll Get
The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community.
Work-life balance, flexibility, and the autonomy to do great work.
Medical, dental, and vision coverage along with numerous health and wellness programs.
Parental leave and support plus adoption and surrogacy assistance.
Career development programs and tuition reimbursement for continued education.
401k match including an annual company contribution
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
Skills
Action Planning, Business, Business Strategies, Coaching, Customer Satisfaction, Decision Making, Leadership, People Management, Performance Improvements, Problem Resolution, Problem Solving, Relationship Building