Provider Contracting Specialist, Consultant

1 week ago


San Diego, California, United States Blue Shield of CA Full time
Job Summary

Blue Shield of CA is seeking a highly skilled Provider Contracting Specialist, Consultant to join our Network Management team. This is a short-term employment position with the potential to be employed for up to 3 years.

About the Role

We are looking for a seasoned professional to support Medical Group/IPA and Hospital/Facility contracting in Southern California for all Blue Shield products.

Key Responsibilities
  • Manage comprehensive provider network contract processes, including derivation, implementation, and ongoing support of assigned provider agreements.
  • Drive department objectives to achieve timely contract negotiations and implementation that support growth and maintain a strong market position and positive reputation.
  • Lead multi-disciplinary teams to implement a new regional structure and help 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 by drafting and managing provider contracts in the contract database.
  • Ensure the efficient implementation and administration of provider agreements with a primary focus on medical groups/IPA's hospitals and ASC's.
  • Improve and maintain accuracy and integrity of new and existing provider contracts to ensure efficiency in contract administration that supports unit costs savings across all products.
Requirements
  • Bachelor's degree in business, healthcare policy, public health or related field, or equivalent experience.
  • 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 and knowledge of healthcare provider networks.
  • Excellent analytical and problem-solving skills, including knowledge of financial impact analysis.
  • Experience in Microsoft Office, including Word, Excel, PowerPoint, and Outlook.
  • Strong organizational skills, detail-orientation, and prioritization, and multi-tasking, with ability to manage multiple tasks efficiently.
Pay Range

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

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade.

Blue Shield salaries are based on a variety of factors, including the candidate's experience, location, and current employee salaries for similar roles.



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