Provider Contracting Specialist, Consultant

1 week ago

Woodland Hills, United States Blue Shield of CA Full time

***This is a Short Term Employment opportunity that has the ability to be employed up to a maximum of 3 years***

Your Role

The Provider Contracting team is responsible for contract negotiations, coordination, and ongoing support and interpretation of contracts for both internal and external partners. The Provider Contracting Specialist, Consultant will be responsible for negotiating provider agreements and accountable care collaboration agreements with medical groups/IPAs, hospitals, and ambulatory surgery centers. Reporting to the Director, Provider Contracting & Provider Relations, this role will drive strategic initiatives to support Blue Shield of California's objectives to achieve growth and maintain strong market position and positive reputation in the market.

Your Work

In this role, you will:

  • Negotiate all product (commercial, Medicare, and Medi-Cal) provider agreements with medical groups/IPAs, hospitals, freestanding ambulatory surgery centers and accountable care collaboration agreements
  • Participate in cross-functional team to implement initiatives to help manage the total cost of health care across the assigned region
  • Collaborate closely with Medical Management, Provider Relations, Network Analytics, and Sales to meet aggressive regional goals
  • Drive alignment with Pricing, Underwriting, and Sales regarding unit cost and other contracting activities
  • Identify strategic opportunities within local market (i.e., network expansion opportunities, utilization, or unit cost excesses, etc.)
  • Assess market trends and competitive benchmarks to enhance company's market position
  • Conduct extensive investigation and apply critical thinking to understand root functions and/or businesses to develop new perspectives and innovative approaches on existing or new problems, and communicate with external customers and vendors on new concepts, practices, and approaches
  • Take responsibility for managing large, complex project initiatives of strategic importance to the organization, involving cross-functional teams
  • Frequently be responsible for providing guidance, coaching, and training to other employees across the company within area of expertise
  • Communicate with executive leadership regarding matters of significant importance to the organization, including writing comprehensive executive summaries

Your Knowledge and Experience

  • Requires a bachelor's degree in business, healthcare policy, public health or related field, or equivalent experience
  • Requires at least 7 years provider contracting / negotiation experience including experience managing complex negotiations
  • Requires broad healthcare industry knowledge with substantial experience negotiating and managing complex, high-profile provider contracts
  • Requires advanced knowledge and skills including technical or functional expertise, business acumen, financial analysis, risk management, delegation, critical thinking, and decision making
  • Requires excellent oral and written communication skills

Pay Range:

The pay range for this role is: $109,120.00 to $163,680.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

#LI-MM4

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