Ancillary Network Specialist

The Ancillary Network Specialist will be responsible for managing assigned ancillary professional and institutional provider types. The Ancillary Network Specialist will be responsible for managing the contract maintenance process for assigned provider networks and assist with the variety of tasks that are necessary for the maintenance of our Ancillary provider networks (Enrollment/Credentialing, claims questions, contract operations) In addition, the Network Specialist will help simplify the way providers conduct business with BCBSMA to improve the overall provider experience.

The Day to Day:

• Support Ancillary Network Managers in overall management of assigned providers:
  • Understand all operational aspects of BCBSMA's contracting workflow and procedures for ancillary professional and institutional providers
  • Instruct and educate new providers/office staff regarding BCBSMA products, network application and contracting processes.
  • Understand and promote the medical operations system, including referral management, provider enrollment, credentialing and reimbursement
  • Record provider feedback, network and market intelligence, and key provider concerns and issues
  • Develop and negotiate contracting approaches and methodologies which maximize Blue Cross's competitive position and support its strategic vision of making quality health care more affordable.
  • Respond to both internal and external customers regarding provider contractual arrangements, both for contract implementation and ongoing operations.
  • Single point of contact for areas of the company that we work closely with (enrollment, claims, medical management)
  • Assist in the creation, development, and implementation of new workflows that support internal and external departmental processes
  • Promote and support the use of provider self-service technologies
• Respond to provider inquiries and handle issues:
  • Responsible for first response / triage of inquiries and issues
  • Autonomously resolve, in timely manner, provider issues escalated by BCBSMA Senior Management or internal departments, as appropriate
  • Communicate key information to leadership and make recommendations for process improvements
  • Communicate with internal departments to convey feedback from ancillary professional and institutional providers and identify operational issues
• Manage contractual requirements of BCBSMA and providers:
  • Utilize contract management system to initiate all boilerplate provider contracts while managing inventory within established turnaround times
  • Manage provider movement into, out of, and within contracts
  • Monitor BCBSMA contractual requirements and coordinate among internal business areas to ensure timely adherence
  • Monitor providers' contractual requirements and follow-up with providers as needed

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties.

We're Looking for:

• Knowledge of the healthcare industry (preferably ancillary providers) including local/regional nuances and plan and provider operations
• Understanding of provider contract development; demonstrated understanding of health care reimbursement methods and strategies including experience negotiating with providers.
• Excellent written and interpersonal communication skills including the ability to communicate with confidence, adapt personal style to the audience
• Excellent organizational skills with a focus on attention to detail.
• Demonstrated ability to establish, build and maintain relationships with internal and external constituents
• Ability to influence others to achieve mutually beneficial outcomes and inspire trust

What You Bring:

• 3-5 years Healthcare/Provider Network Management experience preferred
• College Degree (BA/BS) required
• Advanced Degree (MPH, MBA) preferred
• In-depth knowledge of the health care industry, competitive landscape and various health care reimbursement models
• Strong computer system knowledge including Microsoft Office applications. Experience with BCBSMA technologies a plus (including HURON, RTMS, TPS, Salesforce, Right Fax)

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.