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Resp & Qualifications

_We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week._

PURPOSE:

Responsible for planning and managing day to day activities regarding network development. Responsibilities include provider recruiting/contracting for commercial business and government programs, new networks, coordination with the Payment and Practice Transformation Team for value-based contracts, managing department-related RFP responses, tracking hospital-based practices and provider resignations, maintenance of participation agreements, reporting departmental metrics and overall management of all non-standard contract negotiations including single case agreements.

ESSENTIAL FUNCTIONS:

+ Plan and manage all professional, ancillary, and institutional (non-hospital) contracting and departmental staff activities for commercial business and government programs and new networks. This includes negotiations, financial quantification, network impacts, qualification and competitive analyses, implementation and monitoring of all non-standard professional contracts and single case agreements.

+ Manage professional, ancillary, and institutional (non-hospital) network development and recruitment projects. This includes recruitment of professional, ancillary, and institutional (non-hospital) providers in support of business expansion including government programs, corporate projects and Sales department requests. Key functions of proactive recruitment are trending participation levels, identifying network deficiencies/gaps and ongoing reviews for competitive access.

+ Maintain standard professional, ancillary, and institutional (non-hospital) provider agreements, update contract language and draft amendments.

+ Compliance for EEO/AAP and all other CareFirst compliance responsibilities. Ensure that all associates complete the online compliance training and certifications.

+ Submit all departmental regulatory filing and reports by the associated statutory deadlines. Operate department within the expected federal and state legal and regulatory requirements.

SUPERVISORY RESPONSIBILITY:

This position manages people.

QUALIFICATIONS:

**Education Level:** Bachelor's Degree in Finance, Accounting, Health Care or Business Administration OR In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

**Experience:** 5 years in the health care or health insurance industry. 1 year supervisory experience or demonstrated progressive leadership experience.

Preferred Qualifications:

+ Advanced degree as evidenced by MBA, CPA or Nursing Degree.

Knowledge, Skills and Abilities (KSAs)

+ Strong interpersonal skills. Ability to work independently, as well as a member of a team.

+ Ability to maintain effective interpersonal relationships.

+ Excellent communication skills both written and verbal.

+ Proficient in Microsoft Office programs.

+ Deep understanding of multiple reimbursement methodologies used in healthcare provider contracting.

+ Knowledge of provider billing and coding mechanisms.

+ Negotiation skills.

+ Strong analytical skills: able to transform data into clear and relevant information.

+ Working knowledge of medical insurance and managed care principles.

+ Excellent organizational skills and attention to detail.

+ Effective presentation, negotiation and influencing skills to interface with all levels of management and suppliers.

+ Working knowledge of provider community, market and its underlying financial dynamics.

+ Familiarity with general contracting terms and concepts such as privacy and confidentiality, indemnification, insurance, non-disclosure, and remedies and dispute resolution.

+ Strong follow through and problem-solving skills needed.

+ Knowledgeable of CPT and ICD-9 coding systems.

+ Exhibits interest in an understanding of health economics. Embraces the corporate mission to ensure access to affordable care and applies clinical knowledge and skills with the business operations framework.

+ Strong financial acumen.

+ Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

**Salary Range:** $104,640 - $194,238

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Fee For Services Contracting

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

\#LI-NH2

REQNUMBER: 21621