Provider Contracting Specialist, Experienced

Blue Shield of California

  • Long Beach, CA
  • $71,280-99,770 per year
  • Permanent
  • Full-time
  • 1 month ago
Job Description:Your RoleThe 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 WorkIn 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 (i.e., 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.
Qualifications:Your Knowledge and Experience
  • Requires a bachelor's degree in business, healthcare policy, public health or related field, or equivalent experience
  • Requires at least 3 years provider contracting / negotiation/ provider relations experience with increasing complexity
  • Effective project management skills and understanding of contracting administration and general healthcare reimbursement methodologies and knowledge of financial impact analysis.
  • Excellent oral/written, communication and presentation skills, including influence abilities for internal and external discussions
  • 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
  • Experienced in Microsoft Office including, Word, Excel, PowerPoint, and Outlook.
  • Flexible team player who can also work independently
Pay Range:The pay range for this role is: $ 71280.00 to $ 99770.00 for California.Note: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 (California, Bay area, or outside California), and current employee salaries for similar roles.About the Team:Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!Our Values:
  • Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
  • Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
  • Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model:Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That's why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.Two ways of working: Hybrid (our default) and office
  • Hybrid - In a business unit approved office a few times per year to 3 days per week, on average
  • Office - In a business unit approved office 4+ days a week, on average. If the role you're applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.
Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.Equal Employment Opportunity:External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Blue Shield of California