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Blue Cross & Blue Shield jobs in Meridian, ID - 9 jobs

  • Provider Relations Representative

    Blue Cross and Blue Shield Association 4.3company rating

    Blue Cross and Blue Shield Association job in Meridian, ID

    Blue Cross of Idaho (BCI) is seeking a Provider Relations Representative to act as a primary liaison between the organization and healthcare providers. In this independent role, you will maintain open communication regarding provider policies and payment procedures while training and education providers on BCI contact requirements and operational procedures. We are looking for a Provider Relations Rep with: Provider Relations Rep I: * Experience: 4 years' provider service or health industry experience * Education: High School or equivalent Provider Relations Rep II: * Experience: 8 years' provider service or health industry experience * Education: High School or equivalent What your day may look like: * Coordinates the resolution of provider contracts, agreements, fee schedules, and payment problems. * Collaborates with key stakeholders to identify and resolve issues. * Coordinate's resolution of contract or agreement issues. Communicates critical issues and provides recommendations to leaders. * Educates providers on policies, procedures, practices, and data integrity. Ensures providers are informed on changes/updates to policies, procedures, and practices. * Ensures department and provider compliance with regulatory agencies. * Coordinates cross departmental activities and projects to support and adhere to the provider contract requirements. * Performs research to respond to inquiries and interprets policy and procedures to determine effective response. * Provides welcome information to newly contracted providers. * Promotes provider participation in on-line tools and programs available. * Performs other duties and responsibilities as assigned. As of the date of this posting, a good faith estimate of the current pay range is $26.12 to 36.58 for a level I and $66,353 - $92,894 for a level II. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies. Reasonable accommodations To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
    $66.4k-92.9k yearly Auto-Apply 12d ago
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  • Pharmacist in Charge - Emerald Specialty Pharmacy

    Blue Cross and Blue Shield Association 4.3company rating

    Blue Cross and Blue Shield Association job in Meridian, ID

    Join Us in Shaping the Future of Specialty Pharmacy Blue Cross of Idaho is seeking a visionary Pharmacist in Charge (PIC) to play a pivotal role in launching and operationalizing our new specialty pharmacy line of business. In close collaboration with our VP of Pharmacy and Strategy team, this leader will help build a high-performing pharmacy operation from the ground up-while benefiting from the stability and support of a well-established healthcare organization. This is a rare opportunity to be part of an entrepreneurial initiative within a mature company, where innovation meets impact. If you're passionate about specialty pharmacy and excited by the challenge of creating something new, we invite you to explore this unique role. Position Summary The Pharmacist-in-Charge (PIC) is responsible for establishing and overseeing all pharmacy operations, ensuring full compliance with federal and state regulations, and delivering high-quality pharmaceutical care. This role is essential in development, launching, and sustaining a specialty pharmacy focused on complex specialty pharmacy therapies. This role requires local Idaho onsite presence and reports to the VP, Pharmacy. #LI-Onsite Required Qualifications: * Doctor of Pharmacy (PharmD) or equivalent degree * Active pharmacist license in Idaho. Additional state licenses preferred or ability to gain those state licenses * Minimum 3-5 years of experience in specialty or high-volume pharmacy * Prior PIC experience preferred; startup or buildout experience a plus * Prior experience with specialty pharmacy processes to gain specialty pharmacy or mail order accreditation * Strong knowledge of specialty drug operational dispensing workflows * Strong knowledge of specialty drug inventory management * Analytical problem solver with hands-on execution capability * Ability to successfully manage cross-functional teams and external vendors We'd also love it if you have additional qualifications: * Detail-oriented with strong organizational and leadership skills * Proven experience in specialty pharmacy startup, construction, or multi-site expansion * Entrepreneurial attitude that is required for a startup specialty pharmacy * Ability to support IT resources for successful integration of pharmacy management and clinical patient management systems. * Support for specialty pharmacy data analytics, interpretation, and KPI dashboarding * Able to navigate payer policies, prior authorization workflows and familiarity with HUB coordination and Patient Support programs * Passionate about patient care and operational excellence Key Responsibilities Operational Leadership * Support for specialty pharmacy buildout * Ensure facility meets USP /, DEA, and state Board of Pharmacy standards * Development of operational workflows and processes including prescription intake, reimbursement, dispensing, and inventory management * Development and implementation of standard operating procedures (SOPs) for dispensing, inventory, and clinical processes * Support for coordination of soft launch, pilot testing, and full operational rollout * Lead daily operations including staffing, scheduling, and outside vendor coordination including pharmacy management and clinical management system providers, contracted couriers, and procurement partners * Cross-functional collaboration and internal and external business partner communication Regulatory Compliance * Management of pharmacy licensing, DEA registration, and accreditation (URAC, ACHC, NABP) * Ensure adherence to DEA, FDA, HIPAA, and state Board of Pharmacy regulations * Maintain all required records, logs, and documentation for audits and inspections * Serve as primary contact for regulatory agencies and licensing bodies Clinical Oversight * Managerial oversight of the clinical and dispensing processes and procedures within the specialty pharmacy * Support for the development of clinical pathways, protocols, and care models for targeted therapies for both internal purposes and external entities including pharma manufacturers and payers * Define critical metrics and clinical benchmarks for program success * Monitor adherence, persistence, and adverse event reporting and reconciliation * Support real-world evidence generation and outcomes-based contracting Inventory & Supply Chain * Support for the negotiation of contracts with wholesalers, specialty distributors, GPOs, and courier services * Oversight of specialty pharmacy purchasing and procurement with previous experience collaborating with wholesalers and group purchasing organizations within prime vendor agreements * Development and oversight of procedures for procurement, inventory management proper storage, and disposal of specialty medications * Monitor cold chain integrity, lot-level tracking, and recall procedures * Ongoing operational leader that facilitates coordination with manufacturers, wholesalers, specialty distributors, and GPOs Team Management * Define roles, training plans, and performance metrics * Hire, train, and supervise pharmacists, technicians, and support staff * Foster a culture of compliance, patient safety, and continuous improvement * Development and administration of performance reviews and staff competency assessments Quality & Reporting * Implement quality assurance programs and continuous improvement initiatives in conjunction with accreditation requirements and procedures * Track specialty pharmacy critical metrics such as dispensing accuracy, turnaround time, and patient and provider satisfaction * Preparation of quality reports for internal leadership and external business partners As of the date of this posting, a good faith estimate of the current pay range is: $146,012 - $219,018. The position is eligible for milestone project bonuses, awarded upon successful completion of key projects and based on defined performance criteria. The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, internal equity, geography, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies. Reasonable accommodations To perform this job successfully, you are able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
    $146k-219k yearly Auto-Apply 22d ago
  • Legal Operations Specialist

    Blue Cross and Blue Shield Association 4.3company rating

    Blue Cross and Blue Shield Association job in Meridian, ID

    Are you an experienced legal assistant or legal operations specialist eager to make an impact within a fast-paced, collaborative legal department? Blue Cross of Idaho is excited to invite skilled professionals like you to join our dynamic legal team, where you'll play a key role in supporting our evolving legal needs and partnering with talented colleagues. Our Work Environment If you thrive in a corporate law environment and are ready to bring your expertise to a group that values innovation and teamwork, we want to hear from you. The ideal candidate will demonstrate strong initiative in their work, exhibit a keen understanding of new programs, and show adaptability as policies and procedures are established and implemented to support legal matter workflows. Key Success Factors Success in this role requires the ability to independently navigate evolving processes and actively contribute to the development and maintenance of efficient legal operations. The successful candidate will be comfortable engaging with our electronic billing platform and with outside counsel about invoices submitted to the legal department. Experience and comfort working with legal department budgets is a plus. Candidates who are comfortable conducting legal research will be viewed favorably, as this skill further supports the effective resolution of legal matters in a team environment. Professional Attributes The candidate must be highly trustworthy and exercise impeccable discretion when handling sensitive information and topics. To be considered for this opportunity, you must have: Experience: Three+ years' experience working as a legal assistant in a corporate legal department or law firm setting, or comparable years of experience working in legal operations. Corporate legal department experience is strongly preferred. Education: Bachelor's Degree or equivalent work experience (Two years' relevant work experience is equivalent to one-year college). In this role, you will: Step into a central role with the Blue Cross of Idaho legal team, where your independence and initiative as a legal assistant or legal operations specialist will support a dynamic group of collaborative attorneys and paralegals. In this position, you'll work closely with legal professionals to lead requests for department support, organize and implement workflows, maintain files and matter management system, maintain contracts, and facilitate effective communication with outside counsel. Your direct experience in a law department or law firm will be invaluable as you serve as a primary contact for inquiries from across the company, responding promptly and ensuring requests are triaged efficiently within the team setting. Your responsibilities will include actively participating in budget activities, preparing essential reports, and coordinating meetings and cross-department projects in partnership with team members. You'll be counted on to support legal operations initiatives underway and help develop and curate materials and resources-all while maintaining professionalism and discretion. Success in this role means thriving in a collaborative environment where effective teamwork, organizational skills, and attention to detail drive meaningful results for both the legal department and the broader organization. Join us and help foster a legal team culture where shared knowledge and mutual support shape a healthier, more connected Idaho. As of the date of this posting, a good faith estimate of the current pay range is $28.87/hour to $40.42/hour. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies. Reasonable accommodations To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
    $28.9-40.4 hourly Auto-Apply 32d ago
  • Care Manager

    Blue Cross and Blue Shield Association 4.3company rating

    Blue Cross and Blue Shield Association job in Meridian, ID

    Join Blue Cross of Idaho's growing Healthcare Operations team! In this role, care managers will effectively care-manage members utilizing a collaborative process. Work independently and under limited supervision. Assess, plan, implement, monitor, and evaluate the options and services required to meet an individual's health needs using communication and available resources to promote quality, cost-effective outcomes. What we are looking for in Care Manager: Experience: 3 years' relevant experience Education: Associates Degree in Nursing or Bachelor's Degree in Social Work; or equivalent work experience (Two years' relevant work experience is equivalent to one-year college) Licenses/Certifications: Must hold one of the following: * Valid unrestricted Idaho Registered Nurse License * Valid unrestricted Idaho Social Worker License Preferred Requirement: Masters in Social Work What your day may look like: * Conducts an evaluation of the members' current status including physical, mental, and social determinants of health. * Identifies, plans, implements, and evaluates appropriate health care interventions in conjunction with the physician treatment plan. * Collaborates with member, family, healthcare provider and team members to coordinate care and guide members to the most appropriate, cost effective resources. * Collaborates with members, providers, staff, and stakeholders to assure continuity for members throughout different levels of care they may require. * Provides education and referrals to appropriate community resources. * Tracks and reports quantifiable impact, quality of care, and/or quality of life improvements as measured against long and short-term goals. * Acts as a peer mentor for training new personnel as well as on-going training for staff. * Conducts quality review of work completed by peers and new hires. * Performs other duties and responsibilities as assigned. As of the date of this posting, a good faith estimate of the current pay range $73,321 - $87,985.50. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies. Reasonable accommodations To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
    $73.3k-88k yearly Auto-Apply 8d ago
  • Other Party Liability Specialist I

    Blue Cross and Blue Shield Association 4.3company rating

    Blue Cross and Blue Shield Association job in Meridian, ID

    Blue Cross of Idaho is seeking an Other Party Liability Specialist who will identify, investigate, and collects recoveries from third parties and other insurers who are legally responsible for paying all or part of medical expenditures. Interact with attorneys and third-party insurance professionals to explore where there may be a liability and negotiate and coordinate claim payments. What we are looking for: Experience: 2 years health industry, call center, claims, and/or collections experience. Here's what your day may look like: * Prepares, researches, and analyzes claims reports to identify potential recoveries based on contract guidelines and corporate procedures. * Responds to subrogation inquiries regarding third-party liability policies and procedures. * Develops cases resulting from beneficiary and provider-initiated inquiries, internal referrals, personal research, and/or computer-generated reports. * Negotiates recovery with customers, pharmacies, and other insurance carriers to maximize recovery potential, within established guidelines. * Testifies at court hearings and represents the Company in mediations. * Responsible to understand contractual obligations regarding other party liability cases, and assists enrollees, insurance companies, attorneys, and internal customers with prospective and current other party liability matters for all lines of business. * Communicates with self-funded plan representatives to resolve issues regarding other party liability cases that are outside established guidelines. * Reviews and processes drafts and/or checks and ensures accurate recordkeeping and reporting of activities. * Performs other duties and responsibilities as assigned. As of the date of this posting, a good faith estimate of the current pay range is $20.93 to $29.29. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
    $20.9-29.3 hourly Auto-Apply 6d ago
  • Accounting Specialist (AR)

    Blue Cross and Blue Shield Association 4.3company rating

    Blue Cross and Blue Shield Association job in Meridian, ID

    Blue Cross of Idaho is seeking an Accounting Specialist II or III to perform detailed accounting assignments related to accounts receivable and process daily cash activities timely and accurately. at our Meridian ID campus. Required Experience: 2-4/+ years' accounts receivable experience and cash processing, preferably in an enterprise setting. Experience should also span proficiency in Microsoft office programs (Outlook, Work and Excel). Additional experience with Facets is a plus. Your day may look like: * Input and post premium payments to individual and group accounts. Process cash receipts and input into cash and general ledger systems. Deposit checks into proper bank accounts; reconcile deposits to bank statements on a daily and monthly basis. * Review daily cash flow spreadsheets and ensure cash sheets are correct and reconciled to the bank statements and cash entry system. Ensure payments are applied and posted to accounts daily. * Perform research and request bank documents as needed. * Serve as a backup to determine proper segregation of cash receipts and deposit into appropriate bank account. Sort checks, coupons, and bills received into group, individual (non-group), miscellaneous accounts receivable, claims cash receipts and claims refunds to ensure accurate accounting and timely deposit of funds. * Process NSF checks. * Cash, credit, receipt process, separate between lines of business and enter information from the check, balance the checks, and send them to claims department for further processing. * Close process for cash, credit, receipt. * Special projects as requested. As of the date of this posting, a good faith estimate of the current hourly pay range is: $21.39 - $29.95 (Specialist II); $23.63 - $33.09 (Specialist III). The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, internal equity, geography, business or organizational needs, and alignment with market data. At BCI, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies. Reasonable accommodations To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
    $21.4-30 hourly Auto-Apply 16d ago
  • HIPAA Compliance Specialist

    Blue Cross and Blue Shield Association 4.3company rating

    Blue Cross and Blue Shield Association job in Meridian, ID

    Blue Cross of Idaho is seeking a Compliance Specialist to analyze and distribute new and updated regulatory requirements related to HIPAA and protected health information. The role is also involved in advising business areas of their compliance obligations. The specialist will also be involved in helping to resolve HIPAA privacy issues that emerge. The role will start as a general compliance specialist while also performing work related to HIPAA. Over time the role will transition into a full-time HIPAA Compliance Specialist. Designing the position this way will help the employee gain the necessary background in compliance program effectiveness to apply those skills and knowledge to HIPAA specific compliance work. We're seeking for a Specialist with: Experience: 4 years' health industry, internal audit, legal, compliance, or government programs (12 years of experience if candidate does not have Bachelor's degree) Education: Bachelor's Degree or equivalent work experience (Two years' relevant work experience is equivalent to one-year college) Your day may look like: * Maintains and applies knowledge of regulations and regulatory changes relevant to the industry and the organization - HHS, OCR, SAMSHA, State Privacy Laws, CMS, Department of Labor, Department of Insurance, and others * Performs Privacy incident investigations * Makes independent HIPAA Breach determinations using regulatory required criteria * Facilitates Privacy required notifications * Creating letters for specific incidents, requests and responds to privacy inquiries * Performs risk assessments of 3rd party privacy compliance, including supplier, software, and other business partners * Analysis privacy related trends, suggests remediation and creates communication to report to leadership * Acts as a subject matter expert for regulatory requirements pertaining to BCI Privacy regulations * Ensures regulatory standards are applied to organizational policies and procedures by evaluating and communicating regulatory guidance to impacted business areas. * Responds to compliance and privacy related questions, complaints, and incidences. * Facilitates or supports organizational compliance training on Privacy and general compliance and other topics required by regulation. * Works with business relationship owners and vendors to train, educate, mitigate compliance risks, and drive industry best practices. * Provide support in coordinating third party oversight related to compliance requirements * Assist in communication and education initiatives delivered by Compliance * Support and seek ways to improve compliance risk assessments and maturity evaluations throughout the organization * Coordinate and provide support in resolving third party compliance incidents * Provide support and expertise in the authoring and updating of Compliance department and corporate policies and procedures * Analyze relevant data to find opportunities to improve the organization's compliance program and culture of compliance * Produce and distribute department and organizational reports related to compliance * Performs other duties and responsibilities as assigned. As of the date of this posting, a good faith estimate of the current pay range is $78,064 to $117,095. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies. Reasonable accommodations To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
    $36k-56k yearly est. Auto-Apply 6d ago
  • Provider Network Manager I/II

    Blue Cross and Blue Shield Association 4.3company rating

    Blue Cross and Blue Shield Association job in Meridian, ID

    Develop and maintain positive working relationships with contracted providers. Actively audit and monitor financial performance of all assigned providers to ensure network sustainability. Analyze, review, and project financial impact of contract arrangements. Initiate and maintain effective communication channels with internal business partners. Ensure accurate implementation and administration of contracts. We are looking for a Provider Network Manager with: Level I: 4 years' provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience Level II: 6 years' provider contract/network management, provider reimbursement methodologies, contracting, negotiation, or relevant experience Education: Bachelor's degree or equivalent work experience (Two years' work experience is equivalent to one year of college) What a day of a Provider Network Manager may look like: * Analyze, review, and project financial impacts of network arrangements. * Develop and maintain cost efficient networks and/or programs and identify areas of opportunity for greater efficiency and risk mitigation. * Ensure accurate implementation and administration of executed networks and/or programs. * Implement reimbursement strategies designed to control healthcare costs. * Use data from multiple sources to recommend innovative payment initiatives and methodologies. * Prepare and present financial performance reports on assigned networks to leadership. * Formulate, analyze, coordinate, and negotiate contracts with provider networks. * Maintain documentation related to processes and procedures, training materials, program descriptions and technical program requirements. * Prepare and present to healthcare organizations, clients, and internal business partners. * Established productive, professional provider relationships with key partners and maintains provider satisfaction through assessment and response to on-going provider needs. * May identify provider payment or utilization variations and take action to resolve. Communicates variations to leadership. * Perform other duties and responsibilities as assigned. As of the date of this posting, a good faith estimate of the current pay range is $76,346 to $141,100. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies. Reasonable Accommodations To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
    $76.3k-141.1k yearly Auto-Apply 44d ago
  • Supervisor Provider Relations

    Blue Cross and Blue Shield Association 4.3company rating

    Blue Cross and Blue Shield Association job in Meridian, ID

    Provides education, training, and front-line support to the teams that support providers regarding company policies, processes, and industry regulations. Leads cross departmental activities and projects to support and adhere to the provider contract requirements and operational targets. We are looking for a candidate with: Experience: 5 years relevant experience Education: Bachelor's Degree or equivalent work experience (Two years' relevant work experience is equivalent to one-year college) * Ensures department and provider compliance with regulatory agencies. * Manages and maintains effective relationships and processes with healthcare providers. * Supports initiatives to improve provider satisfaction. * Provides day-to-day oversight of functional area assigned. * Implements operational plans to address needs and process improvements. * Ensures effective workflows, maximizes system efficiencies, monitors quality performance measures, and confirm appropriate completion of work processes. * Provides guidance, coaching, and continuing education to staff. * Establishes goals and objectives for team members. * May partner with leaders in designing, maintaining, and producing management reports to meet departments or company's needs. * Partners with leaders on workflow automation and process optimization * Performs other duties and responsibilities as assigned. As of the date of this posting, a good faith estimate of the current pay range is $78,064 to $117,095. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies. Reasonable accommodations To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
    $78.1k-117.1k yearly Auto-Apply 10d ago

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