Provider Contracting Specialist, Senior

6 days ago

Oakland, CA, United States Blue Shield of CA Full time

Your Role

The PPO Professional Provider Contracting team manages our PPO and Medi-Cal network to maintain network adequacy by contract negotiation, recruitment and building/maintaining professional relationships. The Provider Contracting Specialist, Senior will report to the Provider Contracting Manager. In this role you will ensure the acquisition, servicing and performance of Physicians/Medical Groups and other Specialty Network Providers to the Blue Shield of California contracted network. Support attainment of department goals under the leadership of the Director of Provider Contracting and/or Provider Contracting Manager and ensures alignment of these goals with the company's strategic priorities. Supports review and modification of contracting and cost of health care savings strategies in anticipation of, and in response to, shifts in provider and competitor negotiation approaches. Research opportunities within the assigned local market (i.e., network expansion opportunities, utilization, or unit cost excesses, etc.) and assesses market trends to drive initiatives which enhance company's market position. Other duties as assigned.

Your Knowledge and Experience

  • Requires a bachelor's degree in business, healthcare policy, public health or related field, or equivalent experience

  • Requires at least 5 years provider contracting / negotiation/ provider relations experience including experience managing complex negotiations

  • Strong analytical and problem-solving skills

  • Excellent interpersonal, oral and written communication skills

  • Health care industry/provider network knowledge including data analysis, understanding of provider contract language including provider reimbursement methodologies etc.

  • Ability to develop, organize, analyze, and implement processes and procedures

  • Broad business skills including analysis of strategic alternatives, financial impact analysis and sales experience/exposure

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