Manager, Provider Network Solutions Operations

Under the direction of the Director, Provider Network Solutions Operations, position is responsible for divisional operations activities for the BCBSKS provider networks including enrollment, procedural and record quality initiatives, record maintenance, and provider communications. Designs, implements and monitors procedures to ensure smooth, accurate and timely workflow within the department and works collaboratively across BCBSKS to ensure provider network processes and activities are transparent, and adhere to internal and external audit and compliance requirements. Manage the work of Provider Network Solutions team members ensuring onboarding and network maintenance activities frame a compliant, quality driven provider network to strengthen BCBSKS provider experience and member’s access to our provider network. Provide timely education to department team members. Manage department activities in support of meeting corporate goals and objectives. Ensures the accuracy and timeliness of provider data for directory purposes.

** This position is eligible to work hybrid (3 or more days per week onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

• 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.
• Trust: Work for one of the most trusted companies in Kansas
• Stability: 80 years of commitment, compassion and community
• Flexibility: options to work onsite, hybrid or remote available
• Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The salary range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive salaries that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

• Directs the coordination of activities related to provider contracting and network enrollment. Includes workflow review and assignment, network onboarding activities including contract initiation, record creation and maintenance.
• Establishes goals and objectives supporting the management and supervision the daily activities of the department ensuring alignment with corporate goals and objectives.
• Collaborates with other departments/divisions to attain accurate and up-to-date information for provider network framework requirements, expectations, adequacy, adherence, and experience.
• Responsible for the coordination and general direction of provider network communications to include contracting documents, provider memos, policy updates, network initiatives, etc.
• Identifies problems and designs/recommends team member success needs through guidance and coaching.
• Ensure compliance of all requirements by law for establishing new provider data, as well as maintenance, and storage.
• Identifies, designs, and implements appropriate solutions to staffing, quality and workload problems in a timely and effective manner. Interview, hire, and discipline.
• Provides appropriate and timely performance feedback to staff both formally and informally. Reviews and recommends merit and promotion increases.
• Anticipates the impact of the changing healthcare environment on assigned work areas and adjusts work assignments and processes as necessary to maintain quality and efficient workflow within the department.
• Manages assigned projects meeting deadlines and assuring results meet the business need of the organization.
• Responsible for the creation, updates, and publishing of all Provider Network Solutions policies and procedures for both internal transparency and guidance and external accreditation compliance standards.
• Direct oversight of Supervisor, Provider Network Enrollment and Supervisor, Provider Network Records and Quality. Indirect supervision of assigned team members to each supervisor.

• High School diploma or equivalent required. Bachelor's degree with emphasis in general business, communications, or human relations preferred.
• Minimum of 5 years’ experience in health care industry required.
• Experience in development and maintenance of provider networks, knowledge of contracting processes, health plan compliance and accreditation standards required.
• Three years proven supervisory/management experience required.

• Broad knowledge of health industry as it relates to provider network operations.

• Base compensation is only one component of your competitive Total Rewards package
  • Incentive pay program (EPIP)
  • Health/Vision/Dental insurance
  • 6 weeks paid parental leave for new mothers and fathers
  • Fertility/Adoption assistance
  • 2 weeks paid caregiver leave
  • 5% 401(k) plan matching
  • Tuition reimbursement
  • Health & fitness benefits, discounts and resources