Provider Contracting Specialist, Senior

Company: Blue Shield of California
Location: Rancho Cordova
Posted on: September 21, 2023

Job Description:

The PPO Professional Provider Contracting team manages our PPO 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 CA 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 negotiating approaches.

-Your Role

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The PPO Professional Provider Contracting team manages our PPO 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 CA 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 negotiating 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. -
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Your Work
In this role, you will:

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• Participate in cross-functional team to implement initiatives to help manage the total cost of health care across the assigned region.
  
• Collaborate closely with Medical Management, Provider Relations, Network Analytics and Sales to meet aggressive regional goals.
  
• Drive alignment with Pricing, Underwriting and sales regarding unit cost and other contracting activities.
  
• Identify strategic opportunities within local market (i.e., network expansion opportunities, utilization or unit cost excesses, etc.).
  
• Assess market trends and competitive benchmarks to enhance company's market position.
  
• Negotiate and finalize Independent Provider Agreements including value-based payment models for primary care and other specialty network contracts based upon network analysis and established parameters as directed by Director of Provider Contracting and/or Provider Contracting Manager.
  
• Manage contracting efforts through entire procurement process (end to end) to ensure contracts are administered and implemented accurately.
  
• Assist with recruitment strategies for targeted providers.
  
• Collaborate with the contracting leadership team to ensure best practices in negotiations to achieve aggressive unit cost and overall health care cost targets.
  At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in , Join us!
  
  -Your Knowledge and Experience -
  
  
  
  
  
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  • Requires a bachelor's degree 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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    Pay Range:
    The pay range for this role is: $ 85360.00 to $ 128040.00 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.
    
    
    
    

Keywords: Blue Shield of California, Rancho Cordova , Provider Contracting Specialist, Senior, Other , Rancho Cordova, California