Contracting Specialist

2 days ago

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

About the Role

Blue Shield of California is seeking a skilled Provider Contracting Specialist, Experienced to join our Provider Contracting team. As a key member of our team, you will play a critical role in negotiating and implementing cost-effective and competitive contractual relationships with our network of professional providers.

Your Responsibilities

In this role, you will:

  • Manage day-to-day contracting operations for our 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, and unit cost excesses
  • Be responsible for provider contract negotiations, drafting, and managing provider contracts in our 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, including Law Department, Medical Management, Model Contracts, Provider Relations, Analytics, and Sales to implement new or renewing provider contracts
  • 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 Us

Blue Shield of California is a not-for-profit health plan dedicated to providing high-quality, affordable healthcare to our members. We are committed to improving the health and well-being of our communities, and we are seeking talented individuals like you to join our team.

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