Provider Network Executive III Job at Premera Blue Cross
Join Our Team: Do Meaningful Work and Improve People’s Lives
Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.
To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership.
Forbes ranked Premera among America’s 2022 Best Midsize Employers
because we are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!
COVID-19 Vaccination Policy:
To learn more about our COVID-19 vaccination and accommodation requirements, please visit our Careers landing page.
As a Provider Network Executive III, you will develop and maintain effective relationships with strategic or core provider accounts, generally custom or complex in nature, to achieve Premera’s operational and strategic goals, product development strategies, and continuity of Premera’s vision and values. You will negotiate standard to complex agreements, often with innovative funding arrangements, and manage ongoing provider relationships.
This is a virtual/telecommuter position, working from home.
What you’ll do:
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Develop and execute ongoing account management and service strategy to meet corporate strategic/financial objectives.
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Serve as main point of contact for the provider and coordinate all Premera interactions with assigned provider accounts.
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Build and maintain positive physician/provider relationships, generally with more complex accounts. Utilize consultative skills, industry knowledge, and Premera product knowledge to foster a collaborative approach to quality care, network stability and cost containment. Monitor and analyze network performance.
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Develop and maintain effective provider networks (standard and custom), often with complex payment methodologies. Participate in payment and delivery systems innovation initiatives.
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Lead negotiation and implementation of complex or custom provider contracts.
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Complete negotiations within preplanned rate targets, meet timelines, ensure the established implementation period, and perform implementation audits for accuracy of assigned accounts.
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Collaborate with Healthcare Economics in rate development and proposal analysis.
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Establish and lead a multi-disciplinary team to provide operationally excellent service and support to assigned accounts.
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Consult and educate assigned accounts and internal stakeholders, providing industry and cross account expertise. Create provider specific and public presentations.
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Proactively communicate with Provider Strategy & Solutions (PS&S) leadership and internal stakeholders on account status to facilitate proper internal support of account management efforts to ensure that the resulting final contract supports Premera's operational and strategic goals.
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Engage providers to promote the concept and understanding of patient engagement adherence and cost savings preventative programs.
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May also be the lead for the PNE team in resolution of escalated provider concerns/issues, distribution of workload, and provide peer review for contract accuracy. May develop or improve work processes to increase team efficiency.
What you’ll bring:
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Bachelor’s Degree or (4) years of experience in a provider or payer environment. (Required)
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(4) years of experience in payer or provider contracting and managing provider relationships in health care or insurance industry including (2) years of experience negotiating contracts. (Required)
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Master’s Degree in a related field preferred.
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Project management experience.
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Working knowledge of Health Insurance Portability and Accountability Act (HIPAA), the National Committee for Quality Assurance (NCQA), government health care programs, and risk coding.
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Knowledge of network development and provider/vendor network recruitment.
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Knowledge of provider community and market anomalies.
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Demonstrated ability to effectively manage complex contract negotiations.
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Demonstrated ability to develop and execute strategy.
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Strong experience and expertise in Provider Relations.
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Demonstrated successful verbal and written communication skills including ability to develop and deliver public presentations, training, meeting facilitation, and broker presentations.
What we offer
- Medical, vision and dental coverage
- Life and disability insurance
- Retirement programs (401K employer match and pension plan)
- Wellness incentives, onsite services, a discount program and more
- Tuition assistance for undergraduate and graduate degrees
- Generous Paid Time Off to reenergize
- Free parking
Equal employment opportunity/affirmative action:
Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.
If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.
The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.
National Salary Range:
$75,200.00 - $127,900.00
National Plus Salary Range:
$85,000.00 - $144,500.00
- National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.
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