Provider Contracting Specialist, Senior

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 Provider Contracting, Manager. 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 CA contracted network. Support attainment of department goals under the leadership of the Director of Provider Contracting and/or Provider Contracting Manager 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.

Your Work

In This Role, You Will:

• Participate in a cross-functional team implementing initiatives to help manage the total cost of healthcare across the assigned region 
• Collaborate closely with Medical Management, Provider Relations, Network Analytics and Sales to meet aggressive regional goals 
• Drive alignment with Pricing, Underwriting and Sales regarding unit cost and other contracting activities 
• Identify strategic opportunities within local market (i.e., network expansion opportunities, utilization or unit cost excesses, etc.) 
• Assess market trends and competitive benchmarks to enhance the company’s market position 
• Negotiate and finalize Independent Provider Agreements including value-based payment models for primary care and other specialty network contracts based upon network analysis and established parameters as directed by Director of Provider Contracting and/or Provider Contracting Manager
• Manage contracting efforts through the entire procurement process (end to end) to ensure contracts are administered and implemented accurately
• Assist with recruitment strategies for targeted providers
• Collaborate with the contracting leadership team to ensure best practices in negotiations to achieve aggressive unit cost and overall health care cost targets

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
• Provider contracting / negotiation/ provider relations experience 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