Provider Contracting Specialist, Senior
Blue Shield of CA, Rancho Cordova, CA, United States
Your Role
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 Senior Manager, Provider Contracting. 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 California contracted network. Support attainment of department goals and ensure alignment of these goals with the company's strategic priorities. Additionally, this role 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. Researching opportunities within the assigned local market (i.e., network expansion opportunities, utilization, or unit cost excesses, etc.) and assessing market trends to drive initiatives which enhance the company's market position.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Knowledge and Experience
Requires a college degree in Business, Healthcare Policy, Public Health - related field or equivalent experience
Requires 5 years of prior relevant experience in provider contracting / negotiation/ provider relations; 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
Hybrid This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
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The Provider Contracting Specialist, Senior will report to the Senior Manager, Provider Contracting. 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 California contracted network. Support attainment of department goals and ensure alignment of these goals with the company's strategic priorities. Additionally, this role 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. Researching opportunities within the assigned local market (i.e., network expansion opportunities, utilization, or unit cost excesses, etc.) and assessing market trends to drive initiatives which enhance the company's market position.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Knowledge and Experience
Requires a college degree in Business, Healthcare Policy, Public Health - related field or equivalent experience
Requires 5 years of prior relevant experience in provider contracting / negotiation/ provider relations; 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
Hybrid This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
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