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.

• Lead, mentor, and coach a team of Provider Relations Representatives to achieve department objectives, fostering 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 the 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 identifying areas for improvement and implementing 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 by working on projects and initiatives that improve network quality, provider experience, and overall operational efficiency.
• Execute 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 provide general direction of written communications and educational materials to ensure accurate claims coding by providers.
• Collaborate with other Provider Relations Managers and the Manager of Training and Education to 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.
• Implement and participate in training programs to improve the effectiveness of field staff.
• Discuss medical, financial, and administrative policy matters as they impact the provider network in collaboration with the other Provider Relations Managers and the Director of Provider Relations.
• Provide direct input into the development of policies and procedures for the implementation of provider contracts and needed policy memo changes with the collaboration of other Provider Relations Managers and PNS Operations.
• Include 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.

Exempt grade 19; salary range $135,440 – $169,300. Blue Cross and Blue Shield of Kansas offers excellent competitive compensation aimed at retaining and growing talented team members, with offers carefully reviewed to ensure fair, equitable pay aligned with the candidate’s skills, education, experience, and training. The range may vary above or below the stated amounts.

• Make a positive impact:
  Your work will directly contribute to the health and well‑being of Kansans.
• Lead and inspire:
  Guide and mentor your team to achieve their full potential and success.
• Family comes first:
  Total rewards package that promotes the idea of family first for all employees.
• Dynamic work environment:
  Collaborate with a team of passionate and driven individuals.