Your Role

The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Consultant will report to the Senior Manager of Provider Contracting. In this role you will support Medical Group/IPA and Hospital/Facility contracting in Southern 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:

• Attain department goals under the leadership of the Director of Provider Contracting and ensures alignment of these goals with the company's broader strategic priorities
• Continually review and modify contracting and cost of health care savings strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches
• Lead multi-disciplinary teams including Medical Management, Provider Relations, Analytics and Sales 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 (i.e., network expansion opportunities, utilization or unit cost excesses, etc.) and assess market trends to drive initiatives which enhance companies 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 will support unit costs savings across all products, while aligning with provider network performance goals and provider engagement strategy
• 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
• Identify opportunities to improve the contract drafting, negotiation, administration, and implementation processes to help drive initiatives that enhance the company's market position
• Acts as a liaison between Network Management and internal departments and/or external partners

Your Knowledge and Experience

• Requires a bachelor's degree in business, healthcare policy, public health or related field, or equivalent experience
• Requires at least 7 years provider contracting / negotiation experience including experience managing complex negotiations
• Requires effective project management skills and understanding of contract administration and general healthcare reimbursement methodologies and knowledge of healthcare provider networks
• Requires excellent analytical and problem-solving skills, including knowledge of financial impact analysis
• Requires experienced in Microsoft Office including, Word, Excel, PowerPoint, and Outlook;
• Requires strong organizational skills, detail-orientation and prioritization, and multi-tasking, with ability to manage multiple tasks efficiently
• Experience working with a contract management system preferred

Pay Range:

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