Network Maintainer I

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.

Please note that effective Jan. 4, 2022, Blue Cross and Blue Shield of Louisiana implemented a policy requiring any employee who enters any of our offices or who interacts in person with anyone for company business purposes to be fully vaccinated for COVID 19, unless legally entitled to a reasonable accommodation related to religious or medical exemptions. At this time, that policy is suspended and vaccination is not required to enter our facilities. Please note this is subject to change at any point in time to ensure compliance with company policy or government mandates and certain client facing roles may have separate protocols.

Residency in or relocation to Louisiana is preferred for all positions.

This position is mostly remote.

POSITION PURPOSE

The Network Maintainer’s overall goal is to optimize the experience for participating providers, facilities, and the members they treat. The Network Maintainer is responsible for maintaining the provider network in their assigned areas and serving as the primary point of contact for questions, issues, claims status, etc.

NATURE AND SCOPE

• This role does not manage people
• This role reports to this job: SUPERVISOR, PROVIDER NETWORK MAINTAINERS
• Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with:All levels of Plan management, EDI, Network Development, Network Operations, Provider Reimbursement, Marketing, Legal, and Benefits Administration; externally with Providers and office staff personnel.

QUALIFICATIONS

Education

• High School Diploma or equivalent required.
• Bachelor's degree in business, marketing or a related field preferred.

Work Experience

• 1 year of experience in the health care industry, focusing on customer service and establishing/maintaining business relationships with the provider community is required.

Skills and Abilities

• Requires knowledge of CMS rules, regulations, and requirements.
• Knowledge of insurance/healthcare industry and provider credentialing required.
• Knowledge of Medicare required.
• Familiarity with healthcare provider setting/environment is a plus.
• Experience in corporate office setting preferred.
• Ability to navigate through multiple computer programs with ease including but not limited to Microsoft Office Suite (Word, Outlook, Excel, etc.) required.
• Must be highly organized and efficient with strong attention to detail
• Excellent time management skills with ability to work independently and within a team required.
• Ability to multitask and prioritize in a fast-paced, ever-evolving environment required.
• Excellent verbal and written communication skills required.
• Ability to speak to and present to large groups required.
• Excellent customer service and phone etiquette skills required.
• Ability to interact effectively with all levels of staff and personality types required.
• Ability to travel, as needed, with the possibility of overnight stays required.

Licenses and Certifications

• None Required

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Facilitates and builds lasting relationships with participating providers, facilities, and the members they treat.
• Resolves escalated issues on behalf of assigned providers.
• Educates providers on proper use of portals/website for self-service of needs.
• Maintains regular contact with all providers in assigned parishes/counties.
• Administers education and training to providers and office staff, including providers new to the network.
• Verifies and maintains provider information to ensure accuracy as required by CMS.
• Documents detailed visit/contact logs daily/weekly within two weeks of contact.
• Accountable for complying with all laws, regulations and accreditation standards that are associated with duties and responsibilities.
• Assists with special projects as needed.

Additional Accountabilities and Essential Functions

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.

\#LI_MS1

An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

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Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

JOB CATEGORY: Insurance