Your Role
The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Senior will report to the Director, Provider Contracting.
In this role you will support Medical Group / IPA and Hospital / Facility contracting in Southern California for all Blue Shield products.
You will be responsible for comprehensive management of Medical Group / IPA and Hospital / Facility provider network contract processes including derivation, implementation, and ongoing support of assigned provider agreements.
You will support contracting initiatives to drive department objectives to achieve timely contract negotiations and implementation that support growth and maintain strong market position and positive reputation in the market.
Your Work
In this role, you will :
- 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
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