Provider Contracting Specialist

19 hours ago


Los Angeles, California, United States Blue Shield of California Full time

About the Role

The Provider Contracting team at Blue Shield of California is responsible for negotiating cost-effective and competitive contractual relationships with our network of professional providers. As a key member of this team, you will play a critical role in identifying, implementing, and executing regional strategy initiatives to provide quality and affordable access to our members.

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
  • Collaborate 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
  • Improve and maintain accuracy and integrity of new and existing provider contracts to ensure efficiency in contract administration
  • Interact with multi-disciplinary teams 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 and transition them to long-term contracts

About You

We are looking for a highly skilled and experienced Provider Contracting Specialist to join our team. If you have a strong background in contract negotiation, healthcare contracting, and provider relations, we encourage you to apply.



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