Provider Contracting Specialist, Associate

Blue Shield of California • Long Beach, CA

22h

About The Position

Your Role The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Associate, will report to the Sr. Manager of Provider Contracting. This position is responsible for negotiating cost-effective and competitive contracts for a variety of provider types, including Cal AIM Providers. In this role, you will 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. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Requirements

• Requires a college degree in Business, Healthcare Policy, Public Health - related field or equivalent experience
• Excellent oral/written, communication and presentation skills, including influence abilities for internal and external discussions
• Excellent analytical and problem-solving skills, including knowledge of financial impact analysis
• Advanced skill in using software programs, including Microsoft Teams Meeting, Outlook, Word, Excel, PowerPoint
• Strong organizational skills, detail-orientation and prioritization, and multi-tasking skills
• Thorough knowledge of common organization-specific and other computer application programs
• Knowledge of and experience utilizing internet search engines for data gathering purposes
• Ability to manage multiple tasks efficiently
• Flexible team player who can also work independently

Nice To Haves

• Two (2) years of prior relevant experience is preferred
• Experience with provider contracting administration, negotiation, and provider relations is strongly preferred
• Experience with and or comprehension of Medi-Cal, and Cal AIM, is preferred
• Effective project management skills and understanding of contract administration and general healthcare reimbursement methodologies and knowledge of healthcare provider networks

Responsibilities

• Manage day-to-day contracting operations for designated Blue Shield of California Promise Cal AIM provider types
• Negotiate and implement provider contracts
• Collaborate as needed with Claims, Provider Relations, and Social Services
• Act as a liaison between Network Management and internal departments and/or external partners
• Identify strategic opportunities within local market (i.e., network expansion opportunities, utilization, or unit cost excesses, etc.)
• 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
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level