Provider Contracting Specialist, Experienced
2 months ago
About the Role
The Provider Contracting team at Blue Shield of California is responsible for establishing and maintaining cost-effective and competitive contractual relationships with our network of professional providers. Our team identifies, implements, and executes regional strategy initiatives to provide quality and affordable access to our members, ensuring long-term sustainability in the network.
Your Responsibilities
- Manage day-to-day contracting operations for Blue Shield of California's CalAIM and Professional Providers Network.
- Negotiate and implement CalAIM and Professional Provider contracts, collaborating closely with Medical Management, Provider Relations, Network Analytics, and Sales to meet aggressive regional goals.
- Identify strategic opportunities within local markets, including network expansion opportunities, utilization, or unit cost excesses.
- Be responsible for provider contract negotiations, drafting and managing provider contracts in the contract database.
- Continually review and modify contracting documents to support cost of healthcare savings strategies in anticipation of and in response to shifts in provider negotiating approaches.
- Improve and maintain accuracy and integrity of new and existing provider contracts to ensure efficiency in contract administration, supporting unit cost 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 manage the total cost of healthcare within the assigned region.
- Act as a liaison between Network Management and internal departments and/or external partners.
- Support company or department projects by researching and providing accurate information as requested by project management teams.
- Demonstrate ability to multi-task with demanding timeframes.
- Answer complex inquiries that require knowledge of departmental policies and procedures.
- Process single case letters of agreements.
- Transition single case letters of agreements to long-term contracts to ensure access to care in a timely and efficient manner in accordance with defined process.
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