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Job Details

Provider Contracting Specialist Senior

Company name
Blue Shield of California

Location
Monterey Park, CA, United States

Employment Type
Full-Time

Industry
Work At Home

Posted on
May 07, 2021

Valid Through
Aug 20, 2021

Profile

Provider Contracting Specialist, Senior','21001JQ','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!','!*!Job Summary

The Provider Contracting Specialist prepares, analyzes, reviews, and projects financial impact of large or complex provider contracts and alternate contract terms. This individual conducts negotiations and drafts individual contracts. Ensures the smooth operation and administration of provider agreements. Focus can be around medical groups/IPA’s, hospitals, Skilled Nursing Facilities, freestanding surgery centers, PPO and specialty benefits. In addition, supports Regional Strategy.  

 

 

Responsibilities

Oversees an annual spend of approximately $20M to $100M in the assigned region.

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.

Guides teams including Medical Management, Provider Relations, Analytics and Sales to implement a new structure and help manage the total cost of healthcare within the assigned region.

Researches 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.

 

 

','!*!Knowledge and Experience

3-5 years provider contracting / negotiation/ provider relations experience including experience managing complex negotiations with a Bachelors degree in Business, Healthcare Policy, Public Health or related field.

Strong analytical and problem-solving skills.

Requires advance knowledge of job area typically obtained through advanced education combined with experience. May have knowledge of project management.

 

 

','!*!Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day.Please click here for further physical requirement detail. ','!*!Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day.Please click here for further physical requirement detail. ','','Provider Contracting','United States of America-California-Monterey Park','','Health Solutions','Full-time','May 7, 2021','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.','Provider Contracting Specialist, Senior

Company info

Blue Shield of California
Website : https://www.blueshieldca.com

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