Provider Contract Specialist - Hybrid

Blue Cross Blue Shield of Arizona • Tampa, FL

1d • Hybrid

About The Position

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona (AZ Blue) aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. This position is hybrid within the state of AZ only, requiring residency and work to be performed within the State of Arizona. The purpose of this job is to focus on Network Adequacy and sufficiency, negotiating and contracting with healthcare providers (such as physicians, behavioral health, ancillary providers, and hospitals) for Arizona Medicaid (AHCCCS) and Dual Eligible Special Needs Plan (D-SNP) business segments, including incorporating value-based payment methodologies into agreements as available and applicable.

Requirements

• 3 years of experience in Healthcare field
• High-School Diploma or GED in field of study
• Valid Arizona Driver License, with an acceptable driving record

Nice To Haves

• 5+ years of experience in provider contract negotiations, contract analysis and modeling, alternative payment methodologies, centers of excellence or equivalent experience in healthcare field.
• Undergraduate degree in Business Administration, Healthcare Administration or equivalent experience in Medicaid or Medicare such as practice administration, provider, or members services, claims and encounters

Responsibilities

• Identify, recruit, and negotiate contracts with various types of providers such as physicians, behavioral health, ancillary providers, facilities (Hospitals/Skilled Nursing) and other healthcare provider specialties.
• Lead contracting process and negotiations for large provider groups, hospitals, ACOs, including value-based agreements or alternative payment models (Level 2-3).
• Initiate and lead committees or workgroups to identify provider partnerships and other network development strategy (Level 2-3).
• Understand and interpret various analyses of the financial structure of contracts to ensure it meets financial targets.
• Recommend language corrections and changes in contract documents to allow for easier administration and ensure compliance with corporate and regulatory guidelines.
• Keep informed of new or updated contracting methodologies, contract languages, and contracting systems, procedures, forms, and manuals.
• Oversee contract setup to ensure accurate claims processing of new and amended contracts.
• Consult and coordinate with various internal departments, external Blue Plans or business partners, providers, business entities, and government agencies as a representative of the contracting team.
• Perform all other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED