Mgr Prov Network Operations at Independence Blue Cross LLC in Philadelphia, Pennsylvania

Job Description:

The Provider Network Operations Manager has the responsibility of the day-to-day oversight of the Provider Data Administration Business Support team.  The team’s job responsibilities require testing various reimbursement methodologies, providing analysis of complex systems, resolution of business and contracting issues related to provider data set-up and quality review. In addition, the manager is also responsible for the development of processes and tools to improve operational efficiency and accuracy within the provider network area. The manager leads and empowers direct reports to identify and conceptualize from a business perspective, what the business needs and pursue innovative solutions to enhance automated processing.

Bachelor’s degree in Business or Healthcare Management.  Six years of progressive experience in healthcare with prior supervisory experience required.  In-depth knowledge of managed care and professional payment systems is required.  Demonstrated knowledge of various operational departments including Claims, Medical Policy, Contracting, Network Data Administration, Network Services, Credentialing and Informational Services is preferred.  Self-motivated, highly organized, detail oriented, as well as possesses above average problem solving, analytical and communication skills (both written and verbal).  The ability to manage complex projects simultaneously and customer expectations to successful conclusion and the ability to interact with all levels of management is required.  Advanced proficiency in CPR, Access, Excel, and Word.