Provider Contracting Specialist, Experienced

Found in: Talent US C2 - 2 weeks ago

Los Angeles, United States Blue Shield of California Full time

Your Role

The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Experienced will report to the Sr Manager of Provider Contracting. In this role you will support Medical Group/IPA and Hospital/Facility contracting in Northern California for all Blue Shield products. You will be responsible for comprehensive management of Medical Group/IPA and Hospital/Facility provider network contract processes including derivation, implementation, and ongoing support of assigned provider agreements. You will support contracting initiatives to drive department objectives to achieve timely contract negotiations and implementation that support growth and maintain strong market position and positive reputation in the market.

Your Work

In this role, you will:

Manage day to day contracting operations for Blue Shield of California. Support attainment of department goals under the leadership of the Director of Provider Contracting and/or Provider Contracting Manager and ensure alignment of these goals with the company’s strategic priorities  Support review and modification of contracting and cost of health care savings strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches  Research opportunities within the assigned local market (, network expansion opportunities, utilization or unit cost excesses, etc.) and assess market trends to drive initiatives which enhance company's market position  Supports the development, negotiation, implementation, and maintenance of a comprehensive provider network. This includes supporting the development of payment policies, alternative payment methodologies, fee schedules, provider communications, and retention strategies, as well as the management of online directories. Continually review and modify contracting documents and support work that derives cost of health care savings strategies in anticipation of, and in response to, shifts in provider negotiating approaches Supports attainment of department goals under the leadership of the Director and ensures alignment of these goals with Blue Shield'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 negotiating approaches. Partners with other team members to meet member and provider service requirements, including identification of network gaps, development and oversight of corrective actions and ongoing management of process improvements. Also identifies service issues across departments, develops process improvements, modifications, and enhancements, and maintains ongoing cross-functional communications. 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 help manage the total cost of healthcare within the assigned region Acts as a liaison between Network Management and internal departments and/or external partners. Performs job responsibilities independently on moderately complex projects/assignments and seeks guidance on projects/assignments of higher complexity. Other duties as assigned.

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