Manager Provider Relations

Overview

Manager of Provider Relations, Provider Network Solutions (PNS) is responsible for overseeing and developing a team of Provider Relations Representatives I's and/or II's to ensure effective provider engagement and support across all lines of business. Reporting to the Director of Provider Relations, this role plays a critical part in educating, motivating, and managing relationships with external healthcare providers, contributing to the strategic goals of both the Provider Network Solutions division and the broader Blue Cross Blue Shield of Kansas (BCBSKS) organization.

$135,440 - $169,300
Exempt grade 19

Blue Cross and Blue Shield of Kansas offers competitive compensation with the goal of retaining and growing talented team members. The salary range is a good faith estimate based on what a successful candidate might be paid. Offers are reviewed to ensure fair, equitable pay, aligned with the individual s skills, education, experience, and training. The range may vary above or below the stated amounts.

• Lead, mentor, and coach a team of Provider Relations Representatives to achieve department objectives. Foster an environment of collaboration, growth, and continuous improvement.
• Serve as a point of escalation for complex issues that may arise with providers, offering solutions and facilitating timely resolutions.
• Ensure clear and open communication between the provider network and internal stakeholders.
• Develop and maintain BCBSKS network of in-network providers for all lines of business.
• Develop and track key performance indicators (KPIs) to measure the effectiveness and productivity of the team. Continuously identify areas for improvement and implement strategies to enhance team performance and provider satisfaction.
• Instruct provider relations representatives in communication and contract work necessary for orientation/education for in-network providers for all lines of business currently contracted for.
• Contribute to the long-term growth and direction of the Provider Network Solutions division, working on projects and initiatives that improve network quality, provider experience, and overall operational efficiency.
• Field activity priorities related to provider education, conflict resolution, contracting and credentialing.
• Select, train, and develop provider relations staff. Evaluate their potential and improve their performance through counseling, training, delegation, and mutual planning of their activities.
• Coordinate and direct written communications and educational materials to assure accurate claims coding by providers.
• In collaboration with the other Provider Relations Managers and the Manager of Training and Education, develop innovative methods and materials such as brochures, audio-visual presentations, posters, manuals and guides to make educational programs and recruitment of in-network providers more effective.
• In collaboration with the other Provider Relations Managers and the Manager of Training and Education, implement and participate in training programs to improve the effectiveness of field staff.
• In collaboration with the other Provider Relations Managers and the Director of Provider Relations, discuss medical, financial and administrative policy matters as they impact the provider network.
• With the collaboration of the other Provider Relations Managers and PNS Operations, provide direct input into the development of policies and procedures for the implementation of provider contracts and needed policy memo changes that must be completed and communicated, including annual mailings of reimbursement and incentive program changes.
• Assist with field utilization review activities by directing field representative contacts and/or personal provider contacts when applicable.
• In collaboration with the Manager of Credentialing, conduct the credentialing office site assessment visitation program (as applicable), and obtain delinquent credentialing materials and other activities related to participation as assigned.
• As directed, interact cross-divisionally with all levels of management and represent provider relations on corporate issues requiring communication.