Provider Contracting Specialist, Consultant
5 days ago
This is a short-term employment position that has the ability to be employed to a maximum of 3 years.
Your RoleThe Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Consultant will report to the Senior Manager of Provider Contracting. In this role, you will support Medical Group/IPA and Hospital/Facility contracting in Southern California for all Blue Shield products. You will be responsible for comprehensive management of Medical Group/IPA and Hospital/Facility provider network contract processes including derivation, implementation, and ongoing support of assigned provider agreements. You will support contracting initiatives to drive department objectives to achieve timely contract negotiations and implementation that support growth and maintain strong market position and positive reputation in the market.
Your Responsibilities- Attain department goals under the leadership of the Director of Provider Contracting and ensure alignment of these goals with the company's broader strategic priorities.
- Continually review and modify contracting and cost of healthcare savings strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches.
- Lead multi-disciplinary teams including Medical Management, Provider Relations, Analytics, and Sales to implement a new regional structure and help manage the total cost of healthcare within the assigned region.
- Identify opportunities within the assigned local market (i.e., network expansion opportunities, utilization or unit cost excesses, etc.) and assess market trends to drive initiatives which enhance the company's market position.
- Support provider contract negotiations by drafting and managing provider contracts in the contract database.
- Ensure the efficient implementation and administration of provider agreements with a primary focus on medical groups/IPA's hospitals and ASC's.
- Improve and maintain accuracy and integrity of new and existing provider contracts to ensure efficiency in contract administration that will support unit costs savings across all products, while aligning with provider network performance goals and provider engagement strategy.
- Interact with multi-disciplinary teams including Law Department, Medical Management, Model Contracts, Provider Relations, Analytics, and Sales to implement new or renewing provider contracts and help manage the total cost of healthcare within the assigned region.
- Identify opportunities to improve the contract drafting, negotiation, administration, and implementation processes to help drive initiatives that enhance the company's market position.
- Act as a liaison between Network Management and internal departments and/or external partners.
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 effective project management skills and understanding of contract administration and general healthcare reimbursement methodologies and knowledge of healthcare provider networks.
Requires excellent analytical and problem-solving skills, including knowledge of financial impact analysis.
Requires experience in Microsoft Office including Word, Excel, PowerPoint, and Outlook.
Requires strong organizational skills, detail-orientation, prioritization, and multi-tasking, with the ability to manage multiple tasks efficiently.
Experience working with a contract management system preferred.
CompensationThe pay range for this role is: $109,120.00 to $163,680.00 for California.
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