Director, Provider Relations and Communication

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.

Residency in or relocation to Louisiana is preferred for all positions.

POSITION PURPOSE

Develops strategic and tactical plans for provider relations, provider engagement and communications, serves as a resource for all departments on provider related issues, acts as a professional resource to answer high-level complex provider relations issues. Responsible for educating providers about the Plan's policies, procedures, provider networks, and claims administration functions. Responsible for all provider education content and public display of provider educational content on Plan's public website. This position must establish and maintain executive level business relationships that assure collaborative communication for initiation, planning and execution of projects specific to provider outreach, education and communications.

NATURE AND SCOPE

• Manages People
• This role directly manages up to 6 employees
• This role directly manages these jobs: Health System Representative; Manager, Provider Communications; Manager, Provider Relations
• This role reports to this job: Vice President, Provider Networks and Contracting
• Necessary Contacts: To do this job effectively, the incumbent has to be in contact with:
  
  All levels of internal and external stakeholders including physicians, hospitals, ancillary providers, provider associations, Provider Contracting, Network Development, Provider Reimbursement, Payment Integrity, Medical Coding, Healthcare Analytics, Strategic Communications, Health & Quality Management, Healthcare Value, Benefits Operations, Medicare Advantage Operations, Provider Credentialing and Data Management, Legal to provide the appropriate and timely resources in support of all provider relations and educational efforts

QUALIFICATIONS

Education

• Bachelor's Degree in a related field is required.
• Four years of related experience can be used in lieu of a Bachelor's degree.

Work Experience

• 3 years of supervisory or management experience required.
• 7 years of experience in the health care industry, focusing on the establishment and maintenance of business relationships with providers in a managed care setting required.

Skills and Abilities

• Knowledge of CMS and other government programs and regulations preferred.
• Must possess thorough knowledge of Provider Relations and Network management that includes developing, implementing and supporting new provider programs.
• Must possess thorough knowledge of typical provider communication needs to assure the Plan's provider network management operation is effectively supported.
• Excellent organizational, interpersonal, and problem solving skills.
• Demonstrated adaptability and flexibility to changes and response to new ideas and approaches.
• Ability to interpret plan/policy requirements and present viable options to upper level corporate management in response to provider needs and concerns.
• Must have demonstrated knowledge and experience in managed care contract terms, end-to-end claims adjudication and payment processes, Plan policies and benefit designs that impact providers, credentialing, provider relations, and contracting relationships unique to insurance, managed care and health care industries. Ability to respond in a professional, positive and consistent fashion to stressful situations in dealing with the public.
• Excellent written and oral communication skills. Must possess well-defined public speaking skills.
• Excellent human relations skills to address, handle and coordinate multiple tasks simultaneously with tact and diplomacy, be action oriented, and engage effectively with different cross-functional groups and senior management as appropriate.
• Ability to use PC based applications (Microsoft Office, Access, etc.) to produce and carry out departmental initiatives/contracting strategies and plans for network development.
• Ability to produce quality, timely results while handling multiple projects often requiring extended working hours.
• Frequent travel throughout the state is necessary.

Licenses and Certifications

• None Required

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Develops effective provider relations outreach and communication strategies and plans to assure providers are informed of policies, programs and accountabilities that support a seamless and good experience for our members and network providers.
• Works closely with providers and other areas of the Plan to identify the network management programs, policies and procedures that impact the providers to assure they are evaluated and impacts appropriately communicated to the company and provider community.
• Serves as the escalation point of contact on significant provider issues that require resolution and resolves issues in a collaborative, effective manner.
• Manages staff level positions by administering all HR functions, including but not limited to, hiring, terminating, conducting performance reviews, managing work schedules, managing a budget, assigning and directing workload, training and developing staff, coaching, etc. to help ensure departmental, divisional and/or corporate goals are set and obtained.
• Interacts with providers to understand the dynamics and needs of the provider community and provides intelligence and key provider network information to senior management as necessary. to assure company is appropriately advised and strategically aligned on current and future network issues.
• Maintains regular, effective communication with contracted providers to promote a collaborative relationship between the Plan and its network providers including participation in provider association meetings and conferences where appropriate.
• Works with internal departments and external stakeholders to implement strategies that result in maintaining a high level of provider satisfaction.
• Directs the continual development, technological improvement and progression of departmental administrative functions related to provider education and outreach as well as communications, ability to know when provider education needs to happen and why. Coordinates with multiple internal departments to develop consistent provider messaging aligned with corporate messaging strategies.
• Assist with standard responses to RFP's and other surveys that relate to all departmental functions.
• Manages the creation, development and administration of the Plan's provider educations and communications program and provides creative and innovative methods of corresponding with the provider community while ensuring consistency in style and accuracy of information in accordance with the Blue Cross and Blue Shield Association and Plan requirements for the purpose of informing and communicating with potential and existing healthcare providers.
• Responsible for the content on the Plan's public website in support of provider education and information.

Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.

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An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

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Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

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