Provider Contract Specialist - Hybrid

Blue Cross Blue Shield of Arizona • Phoenix, AZ

1d • Hybrid

About The Position

Blue Cross Blue Shield of Arizona (AZ Blue) is a Healthiest Employer dedicated to inspiring health and making it easy for individuals, families, and businesses through various health insurance products and services. AZ Blue operates with a hybrid workforce strategy called Workability, offering flexibility in work location. This specific position is classified as hybrid, requiring the employee to reside and work within the State of Arizona, with an expectation to be onsite at least once per week for individual contributors. The purpose of this role is to ensure network adequacy and sufficiency by negotiating and contracting with healthcare providers (including physicians, behavioral health, ancillary providers, and hospitals) for Arizona Medicaid (AHCCCS) and Dual Eligible Special Needs Plan (D-SNP) business segments, incorporating value-based payment methodologies where 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
• Number of Employees: 501-1,000 employees