Provider Contracting Specialist, Consultant
3 days ago
The Provider Contracting Specialist, Consultant will play a crucial role in supporting the Network Management team in managing provider contracting and relations statewide. This position will report to the Senior Manager of Provider Contracting and will be responsible for comprehensive management of Medical Group/IPA and Hospital/Facility provider network contract processes.
Key Responsibilities- Contract Management: Derive, implement, and support assigned provider agreements, ensuring timely contract negotiations and implementation that support growth and maintain a strong market position.
- Contract Negotiation: Lead multi-disciplinary teams to implement new regional structures and manage the total cost of healthcare within the assigned region.
- Market Analysis: Identify opportunities within the assigned local market, assess market trends, and drive initiatives to enhance the company's market position.
- Contract Administration: Ensure the efficient implementation and administration of provider agreements with a primary focus on medical groups/IPAs, hospitals, and ASCs.
- Contract Drafting: Support provider contract negotiations by drafting and managing provider contracts in the contract database.
- Contract Improvement: Identify opportunities to improve the contract drafting, negotiation, administration, and implementation processes to drive initiatives that enhance the company's market position.
- Education: Bachelor's degree in business, healthcare policy, public health, or a related field, or equivalent experience.
- Experience: At least 7 years of provider contracting/negotiation experience, including experience managing complex negotiations.
- Skills: Effective project management skills, understanding of contract administration and general healthcare reimbursement methodologies, and knowledge of healthcare provider networks.
- Software: Experienced in Microsoft Office, including Word, Excel, PowerPoint, and Outlook.
Blue Shield of California is a not-for-profit health plan dedicated to providing high-quality, affordable healthcare services to its members. We are committed to improving the health and well-being of our members and the communities we serve.
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