Provider Contracting Specialist, Consultant

5 days ago


Shingle Springs, California, United States Blue Shield of CA Full time
About the Role

The Provider Contracting Specialist, Consultant will play a critical role in supporting the Network Management team in managing provider contracting and provider 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
  • Support Medical Group/IPA and Hospital/Facility contracting in Southern California for all Blue Shield products.
  • Manage comprehensive provider network contract processes, including derivation, implementation, and ongoing support of assigned provider agreements.
  • Support contracting initiatives to drive department objectives and achieve timely contract negotiations and implementation.
  • Lead multi-disciplinary teams to implement new regional structures and manage the total cost of healthcare within the assigned region.
  • Identify opportunities within the assigned local market to drive initiatives that enhance the company's market position.
  • Support provider contract negotiations and ensure the efficient implementation and administration of provider agreements.
  • Improve and maintain accuracy and integrity of new and existing provider contracts.
  • Interact with multi-disciplinary teams to implement new or renewing provider contracts and manage the total cost of healthcare within the assigned region.
  • Identify opportunities to improve contract drafting, negotiation, administration, and implementation processes.
Requirements
  • Bachelor's degree in business, healthcare policy, public health, or related field.
  • At least 7 years of provider contracting/negotiation experience, including experience managing complex negotiations.
  • Effective project management skills and understanding of contract administration and general healthcare reimbursement methodologies.
  • Excellent analytical and problem-solving skills, including knowledge of financial impact analysis.
  • Experience working with a contract management system.
Pay Range

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



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