HealthRules Medicare Provider Sr Manager
Accenture, Morristown, TN, United States
We Are:
Accenture is a global professional services company with leading capabilities in digital, cloud, and security. Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Interactive, Technology, and Operations services—powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries.
You Are:
A senior delivery leader with deep expertise in Medicare provider networks, Blue Cross Blue Shield (BCBS) implementations, and HealthEdge HealthRules Payor. You bring hands‑on experience designing and implementing provider networks that support BlueCard® participation, inter‑plan arrangements, and complex Medicare contracting models.
Key Responsibilities:
Provide end-to-end leadership for Medicare provider and supplier network implementation within HealthRules Payor, including BCBS‑affiliated plans
Lead design efforts supporting BlueCard provider networks, ensuring accurate cross‑plan participation and claims readiness
Own provider network strategy and setup, including suppliers (TINs), practitioners, practitioner roles, and supplier locations
Provider networks aligned to BCBS and BlueCard participation rules
Medicare provider contracts, reimbursement structures, and fee schedules
Translate BCBS, BlueCard, and Medicare regulatory requirements into scalable HealthRules configuration solutions
Ensure HealthRules business rules integrate seamlessly with enterprise claims, billing, and downstream operational systems
Advise configuration, testing strategy, and documentation for HealthRules Payor and Designer components
Partner with Functional, Integration, Data, and Testing leads to ensure cohesive, end-to‑end delivery across complex workstreams
Serve as a primary client adviser for BCBS provider network and BlueCard‑related topics, guiding decision‑making and issue resolution
Proactively identify and mitigate risks related to provider network setup, BlueCard compliance, and Medicare claims impacts
Contribute to practice growth, delivery assets, and capability development within Accenture’s Medicare and payer technology practice.
Travel
Travel may be required for this role. The amount of travel will vary from 0 to 100% depending on business need and client requirements.
Here’s What You Need:
Minimum of 5 years of functional business experience in the health payer industry, with deep expertise in Medicare, Provider, or BCBS operating models.
Minimum of 3 years of experience implementing provider networks for Blue Cross Blue Shield plans, including support for BlueCard participation.
Minimum of 3 years of hands‑on experience implementing or supporting HealthEdge HealthRules Payor, including HealthRules Designer.
Experience leading full life‑cycle implementations aligned to the Software Development Life Cycle (SDLC).
Bachelor’s degree or equivalent (minimum 12 years’ work experience). If Associate’s Degree, must have equivalent minimum 6‑year work experience.
Compensation
Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience.
Equal Employment Opportunity Statement
We believe that no one should be discriminated against because of their differences. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law. Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities.
Accommodation and Reasonable Accommodation
Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process.
Equal Employment Opportunity Employer
Accenture is an EEO and affirmative action employer of veterans/individuals with disabilities. Accenture is committed to providing veteran employment opportunities to our service men and women.
Work Authorization
Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.
Additional Information
Please read Accenture’s Recruiting and Hiring Statement for more information on how we process your data during the recruiting and hiring process.
#J-18808-Ljbffr
Accenture is a global professional services company with leading capabilities in digital, cloud, and security. Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Interactive, Technology, and Operations services—powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries.
You Are:
A senior delivery leader with deep expertise in Medicare provider networks, Blue Cross Blue Shield (BCBS) implementations, and HealthEdge HealthRules Payor. You bring hands‑on experience designing and implementing provider networks that support BlueCard® participation, inter‑plan arrangements, and complex Medicare contracting models.
Key Responsibilities:
Provide end-to-end leadership for Medicare provider and supplier network implementation within HealthRules Payor, including BCBS‑affiliated plans
Lead design efforts supporting BlueCard provider networks, ensuring accurate cross‑plan participation and claims readiness
Own provider network strategy and setup, including suppliers (TINs), practitioners, practitioner roles, and supplier locations
Provider networks aligned to BCBS and BlueCard participation rules
Medicare provider contracts, reimbursement structures, and fee schedules
Translate BCBS, BlueCard, and Medicare regulatory requirements into scalable HealthRules configuration solutions
Ensure HealthRules business rules integrate seamlessly with enterprise claims, billing, and downstream operational systems
Advise configuration, testing strategy, and documentation for HealthRules Payor and Designer components
Partner with Functional, Integration, Data, and Testing leads to ensure cohesive, end-to‑end delivery across complex workstreams
Serve as a primary client adviser for BCBS provider network and BlueCard‑related topics, guiding decision‑making and issue resolution
Proactively identify and mitigate risks related to provider network setup, BlueCard compliance, and Medicare claims impacts
Contribute to practice growth, delivery assets, and capability development within Accenture’s Medicare and payer technology practice.
Travel
Travel may be required for this role. The amount of travel will vary from 0 to 100% depending on business need and client requirements.
Here’s What You Need:
Minimum of 5 years of functional business experience in the health payer industry, with deep expertise in Medicare, Provider, or BCBS operating models.
Minimum of 3 years of experience implementing provider networks for Blue Cross Blue Shield plans, including support for BlueCard participation.
Minimum of 3 years of hands‑on experience implementing or supporting HealthEdge HealthRules Payor, including HealthRules Designer.
Experience leading full life‑cycle implementations aligned to the Software Development Life Cycle (SDLC).
Bachelor’s degree or equivalent (minimum 12 years’ work experience). If Associate’s Degree, must have equivalent minimum 6‑year work experience.
Compensation
Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience.
Equal Employment Opportunity Statement
We believe that no one should be discriminated against because of their differences. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law. Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities.
Accommodation and Reasonable Accommodation
Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process.
Equal Employment Opportunity Employer
Accenture is an EEO and affirmative action employer of veterans/individuals with disabilities. Accenture is committed to providing veteran employment opportunities to our service men and women.
Work Authorization
Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.
Additional Information
Please read Accenture’s Recruiting and Hiring Statement for more information on how we process your data during the recruiting and hiring process.
#J-18808-Ljbffr