Provider Data And Network Management Manager

Bluecross Blueshield Of South Carolina Columbia , SC 29209

Posted 2 days ago


Responsible for management/maintenance of provider systems within private business. Ensures networks, provider designations, and benefit applications are monitored to be in compliance with our corporate contractual obligations. Leads corporate projects involving provider systems to ensure changes are managed/integrated within claims system appropriately. Responsible for supplying accurate information used in provider contracting, managed care services.

Work hours are Monday through Friday from 8 a.m. to 4:30 p.m.

Travel as required.


  • 30% Develops and maintains corporate provider file to include managing system updates required along with the integration of the system into AMMS. Resolves problems related to network agreements, provider data integrity, and benefit files coordination based on provider classifications and benefit structures.
  • 25% Manages network participation to include oversight of the networks within PIMS (preferred blue, state health plan, Medicare advantage) and produces directories to meet line of business needs. Identifies and executes changes to improve efficiency and timeliness of provider data entry.
  • 25% Selects, trains/guides, and manages staff. Ensures excellent customer service is given to internal employees/customers, business units, and external customers. Prepares, monitors, and analyzes cost center expenditures.
  • 10% Manages/reviews reporting to ensure the file is updated correctly and claims are being processed based on network and provider classifications as indicated in benefit contracts with our customers. Produces and/or reviews reports necessary to support the contracting and managed care functions. Ensures quality reviews are completed to ensure compliance and minimizes claims errors due to incorrect file updates.
  • 5% Develops and supports tiered member accounts by working with business leaders in determining best approaches for supporting new groups. Works with different member groups to understand needs.
  • 5% Supports BCBSSC's initiatives with BlueCross BlueShield Association for improvements and supports new requirements as it relates to provider data processing and development of member transparency tools.

Required Education:

  • Bachelor's degree in Accounting, Business Administration, Computer Science, Nursing, or other job related field, OR
  • Four years of job related work experience.

Required Work Experience:

  • Five years of provider network, business office, or provider/insurance experience including either two years of

supervisory experience OR two years of equivalent military experience in grade E4 or above.

Required Skills and Abilities

  • Strong knowledge of word processing, spreadsheet and database software.

  • Excellent oral and written communication skills.

  • Excellent organizational, customer service and presentation skills.

  • Excellent analytical or critical-thinking skills.

  • Excellent problem-solving skills.

  • Proficiency in spelling, grammar, punctuation and basic business math.

  • Ability to persuade, negotiate with and influence others.

  • Ability to handle confidential or sensitive information with discretion.

  • Ability to listen effectively and respond quickly.

  • Microsoft Office skills.

  • Strong knowledge of Microsoft Access, Easytrieve, DB2, or other database software.

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 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.

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Provider Data And Network Management Manager

Bluecross Blueshield Of South Carolina