Your Role
The Provider Contracting team is responsible for negotiating cost-effective and competitive contractual relationships with Blue Shield of California’s network of professional providers.
We are responsible to identify, implement, and execute regional strategy initiatives, as well as support of health care strategies, to provide quality and affordable access to our members, and deliver long-term sustainability in the network.
The Provider Contracting Specialist, Experienced will report to the Sr. Manager of Provider Contracting.
Your Work
In this role, you will :
- Manage day-to-day contracting operations for Blue Shield of California's CalAIM and our Professional Providers Network
- Negotiate and implement CalAIM and Professional Provider contracts
- Collaborate closely with Medical Management, Provider Relations, Network Analytics and Sales to meet aggressive regional goals
- Identify strategic opportunities within local market (, network expansion opportunities, utilization, or unit cost excesses, etc.)
- Be responsible for provider contract negotiations by drafting and managing provider contracts in the contract database
- 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
- Act as a liaison between Network Management and internal departments and / or external partners
- Support company or department projects by researching and providing accurate information as requested by project management teams
- Demonstrate ability to multi-task with demanding timeframes
- Answer complex inquiries that require knowledge of departmental policies and procedures
- Process single case letters of agreements
- Transition single case letters of agreements to long term contracts to ensure access to care in a timely and efficient manner in accordance with defined process
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