Blue Shield of California
Woodland Hills, CA, United States
Work At Home
May 07, 2021
Aug 20, 2021
Provider Contracting Specialist, Principal','21001L0','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 is responsible for contract negotiations, coordination, ongoing support and interpretation of contracts for both internal and external partners. This will include negotiating all product (commercial, Medicare and Medi-Cal) agreements with medical groups/IPAs, hospitals, and freestanding ambulatory surgery centers and negotiating accountable care collaboration agreements.
Oversees an annual spend of nearly $80M - $600M.
Participates in cross-functional team to implement initiatives to help manage the total cost of health care across the assigned region.
Collaborates closely with Provider Partnership, Medical Management, Provider Relations, Network Analytics and Sales to meet aggressive regional goals.
Drives alignment with Pricing, Underwriting and sales regarding unit cost and other contracting activities.
Identifies strategic opportunities within local market (i.e., network expansion opportunities, utilization or unit cost excesses, etc.).
Assesses market trends and competitive benchmarks to enhance company’s market position.
Other duties as assigned.
Implements strategic goals established by functional leadership.
Problems and issues faced are numerous, and typically undefined where information is difficult to obtain.
Conducts extensive investigation, critical thinking to understand root cause of problems.
Problems span a wide range of difficult and unique issues across functions and/or businesses.
Develops new perspectives and innovative approaches on existing or new problems. Applies agile methods.
Communicates with parties within and outside of own job function.
Has responsibilities for communicating with parties’ external to the organization, which may include customers or vendors.
Works to influence others to accept job function’s view/practices, and agree to or accept new concepts, practices, and approaches.
Requires ability to communicate with executive leadership regarding matters of significant importance to the organization, including writing executive summaries.
Frequently responsible for providing guidance, coaching and training to other employees across the company within area of expertise.
Responsible for managing large, complex project initiatives of strategic importance to the organization, involving large cross-functional teams.
May direct the work of other individual contributors and/or act as a cross-functional team lead.
','!*!Knowledge and Experience
7-10 years provider contracting experience with a bachelor’s degree in Business, Healthcare Policy, Public Health or related field or 6 years and a Master's degree; or a PhD with 3 years of experience.
Broad health care industry knowledge with substantial experience in managing complex and high-profile provider negotiations.
Requires mastery level knowledge of job area typically obtained through advanced education combined with experience.
Excellent oral and written communication skills.
','!*!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-Woodland Hills','United States of America-California-Rancho Cordova','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, Principal
Blue Shield of California
Website : https://www.blueshieldca.com