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Provider Contracting Specialist, Senior

  • Job
    Full-time
    Senior Level
  • Business, Operations & Strategy
  • Long Beach, +1

AI generated summary

  • You need a Bachelor's degree, 5+ years of provider contracting experience, strong communication and project management skills, financial analysis knowledge, and proficiency in Microsoft Office. Flexibility, organization, multitasking, and negotiation skills are a must.
  • You will draft and manage provider contracts, negotiate agreements, and collaborate with multiple teams to drive cost savings and improve provider network performance.

Requirements

  • Bachelor's degree in Business, Communications, or related field preferred, or equivalent experience required
  • 5 or more years provider contracting administration experience including experience managing complex projects
  • 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. Experience working with a contract management system preferred
  • Strong organizational skills, detail-orientation and prioritization, and multi-tasking. Flexible with ability to manage multiple tasks efficiently
  • Flexible team player who can also work independently negotiations

Responsibilities

  • 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
  • Attain department goals under the leadership of the Director of Provider Contracting and ensure alignment of these goals with the company’s broader strategic priorities
  • 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
  • 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.
  • Supports company or department projects by researching and providing accurate information as requested by project management teams

FAQs

What is the primary focus of this role as a Provider Contracting Specialist, Senior?

The primary focus of this role is to support Medical Group/IPA and Hospital/Facility contracting in Southern California for all Blue Shield products.

What are the primary responsibilities of the Provider Contracting Specialist, Senior?

The primary responsibilities include drafting and managing provider contracts, implementing and administering provider agreements, attaining department goals, improving contract drafting processes, and acting as a liaison between internal departments and external partners.

What qualifications and experience are required for this role?

A Bachelor's degree in Business, Communications, or a related field is preferred, along with 5 or more years of provider contracting administration experience. Strong communication skills, project management experience, knowledge of healthcare reimbursement methodologies, and proficiency in Microsoft Office are also required.

How does the Provider Contracting Specialist, Senior contribute to cost savings strategies in healthcare?

The Specialist contributes to cost savings strategies by improving the accuracy and integrity of provider contracts, identifying opportunities for cost savings in contract negotiations, and supporting initiatives that enhance the company's market position.

What type of teams does the Provider Contracting Specialist, Senior interact with in their role?

The Specialist interacts with multi-disciplinary teams including the Law Department, Medical Management, Model Contracts, Provider Relations, Analytics, and Sales to implement and manage provider contracts and ensure cost-effective healthcare delivery within the assigned region.

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Finance
Industry
5001-10,000
Employees
1939
Founded Year

Mission & Purpose

Blue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. Blue Shield of California is a tax-paying, nonprofit, independent member of the Blue Shield Association with 4.7 million members, 7,800 employees, and $22.9 billion in annual revenue. Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. Blue Shield of California complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.