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Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position.

Arkansas Blue Cross is only seeking applicants for remote positions from the following states:

Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.

Workforce Scheduling

Flex

Job Summary

The Network Development Representative Senior (NDR) provides orientations, tools and resources to improve administrative performance and encourage quality improvement performance of providers. Incumbent develops and maintains a positive relationship with physicians, providers, and practice managers within the network, including oversight and managing performance in various incentives based and/or value based programs. The incumbent also coordinates the programs and services; resolving problems, ensuring effective education and reporting, and to proactively identify performance improvement opportunities through analysis and discussions with health care providers.

Requirements

EDUCATION

Bachelor's degree in Health Sciences, Health Care Administration, Business Management, or related field. In lieu of degree, five (5) years' health care, healthcare financing, statistics/analytics, and/or claims administration.

EXPERIENCE

Minimum five (5) years' health plan or provider experience in Provider Relations such as provider relations, provider contracting, network management, healthcare analytics, risk and/or value based contracting, office manager/administrator or other equivalent experience.

Experience establishing relationships and resolving business issues with health plans, provider group or hospital systems preferred.

ESSENTIAL SKILLS & ABILITIES

Oral & Written Communication skills

Problem Solutions

Communication Research

Time Planning

Build Positive Relationships

Educational Presentations

Business Leadership

Professional Collaboration

Project Management

Strategic Planning

Interpersonal Relationship Management

Time planning

Work independently

Skills

Ability to work independently, Cultivate Relationships, Detail-Oriented, Interpersonal Relationships, Managing Deadlines, Oral Communications, Presentations

Responsibilities

Able to travel in service region, up to 75% of the time, Assists with development, implementation, and coordination of an effective quality assurance program, Conducts required site visits, audits or surveys and reports results, Coordinates provider network activities in the assigned region(s) and supports ongoing operations of the networks, such as contracting, data integrity, communications, and relationship management, Educates providers on new or changing programs administered within the enterprise, payment transformation initiatives, and primary care strategies. Assists less experienced representatives in educational initiatives as needed, Maintains and shares intimate knowledge of the changing healthcare dynamics impacting the Medicare provider community and the products and plans offered by the competitive payers, Obtains and maintains participating agreements with health care providers, secures applications for provider numbers, educates new providers, and provides the continuing education of established providers, Organizes time, travel, workflow and work independently assisting providers with inquiries and problems while working closely with other regions and functional areas to coordinate resolutions, Performs other duties as assigned, Provides guidance and technical instruction to less knowledgeable representatives, Researches and utilizes manuals, newsletters, and other source documents in order to resolve problems or respond to specific inquiries, Serves as a principle point of contact for business/financial relationships with providers for all lines of business, Takes the lead and participates in the development and strategy of provider programs and services, such as incentive and provider performance programs, clinical and quality engagement, data sharing, documentation and coding, Star Ratings and HEDIS performance while improving the member experience

Certifications

Security Requirements

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties

Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

Employment Type

Regular

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.