Provider Network Services Director
Columbia, SC 
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Posted 1 day ago
Job Description
Summary Directs development and maintenance of provider network. Provides guidance and direction over staff responsible for any or all of the following areas within the network: provider relations, provider contracting, recruitment, fee negotiations, customer services,
credentialing, and database managementDescription 

*60% 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.

*20% Works with multiple lines of business and maintains relationships with multiple director vendors to meet business needs.

*10% 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.

*5% Assists with the direction of the BCBSSC website to improve member experience with transparency tools.

*5% Supports tiered member accounts by working with business leaders in determining the best approaches for supporting new groups and to meet their needs.

Required Education:

  • Bachelor's degree in Business, Healthcare Administration, or other job related field ORfour years of related work experience.

Required Work Experience:

  • Eightyears of provider network management, provider operations experience to include healthcare network development/contracting or negotiating/maintaining contracts.

  • Two years of management experience ORtwo years of equivalent military experience in grade E4 or above (may be concurrent with theeight 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.



 

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

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 abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. 

 

Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
4+ years
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