Provider Network Services Director

Summary
 Why should you join the BlueCross BlueShield of South Carolina family of companies?
Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Position Purpose:
The Provider Network Services Operations Director provides direction and oversees the operational areas of provider network services including the inquiry center, enrollment pending, staff production, E-commerce, training, or other centers as required. Establishes/maintains timeliness on provider network enrollment to remain compliant with current market regulations/expectations. Enter successfully into new markets as required. This is a fast-paced work environment that would benefit from a leader who is innovative, agile focused, and able to motivate and develop their team for personal growth and greater production.
Description
 

Logistics:

This is a full-time position working (40-hours/week) Monday-Friday 8:00am – 5:00pm working on-site at Percival Road in Columbia SC, in an office environment with occasional travel.

What You’ll Do:

• Develops and maintains provider network.

• Directs and oversees activities and staff.

• Maintains working knowledge of current and proposed regulations of state and federal law, which could affect provider contracting and healthcare delivery.

• Supports and helps design solutions for provider data that multiple lines of business can leverage as business needs change.

• Recommends changes to upper-level management as needed.

• Applies changes in how provider data in maintained so that different LOB’s can leverage the changes.

• Ensures contract compliance and problem solution.

• Works with multiple lines of business and maintains relationships with multiple director vendors to meet business needs.

• Supports BCBSSC’s initiatives with BlueCross BlueShield Association for improvements and supports new requirements as it relates to provider data processing and development of transparency tools.

• Assists with the direction of the BCBSSC website to improve member experience with transparency tools.

• Supports tiered member accounts by working with business leaders in determining the best approaches for supporting new groups.

To Qualify For This Position, You’ll Need:

• Required Education: Bachelor's in a job related field

• Degree Equivalence: 4 years job related work experience or Associate's and 2 years job related work experience

• Required Work Experience: 8 years of relevant financial/administrative experience in an insurance, managed care or healthcare related setting that may include 4 years of provider network management contracting experience.  2 years of management experience OR 2 years of equivalent military experience in grade E4 or above (may be concurrent with the 8 years).

• Required Skills and Abilities:

  • Knowledge of word processing and spreadsheet software. 

  • Excellent verbal and written communication, customer service, organizational, analytical or critical thinking, and presentation skills. 

  • Good judgment.

  •  Proficient spelling, grammar, punctuation, and basic business math. 

  • Ability to persuade, negotiate or influence, and handle confidential or sensitive information with discretion. 

  • Knowledge of mathematical or statistical concepts with the ability to use complex mathematical calculations.

• Required Software and Tools: Microsoft Office.

What We Prefer You To Have:

• Bachelor's in healthcare administration or business administration STRONGLY preferred

• Master’s Degree in Business Administration or Healthcare Administration

• Ability to prioritize and lead employee development efforts

• 10 + Years Provider network management

• Healthcare operations experience

• Provider Information Management Systems (PIMS) knowledge; Strong PIMS functional ability highly preferred

• Leadership training skills

What We Can Do For You:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits the first of the month following 28 days of employment.  

• Subsidized health plans, dental and vision coverage

• 401K retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Wellness program and healthy lifestyle premium discount

• Tuition assistance

• Service recognition

• Employee Assistance

• Discounts to movies, theaters, zoos, theme parks and more

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications.  This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.