Provider Contracting Specialist

Blue Cross and Blue Shield of Kansas City • Work At Home - Missouri, MO

1d

About The Position

Assists in developing the strategic direction and management of the day to day contracting and network management activities for all provider types.

Requirements

• Bachelor’s degree in Healthcare Administration, Business, Finance or related field
• Must have three to five years prior managed care or health care reimbursement experience in a health system, consulting firm, or with a managed care payor
• Strong financial analytics and contracting background analyzing healthcare utilization, operational and financial data
• Demonstrated experience with payment methodologies, and network management experience for various provider types
• At least 2-3 years as a Strategic Reimbursement & Contracting Analyst
• Prior experience negotiating contracts
• Extensive knowledge claims processing / billing
• Or any combination of education and experience providing the types and levels of knowledge, skills, and abilities required by the job

Nice To Haves

• MBA, Master’s level degree, or equivalent
• Experience writing and interpreting complex contract language specific to provider reimbursement, including thorough knowledge of managed care contracting and negotiation experience.

Responsibilities

• Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers
• Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.
• Initiates and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Analytics departments, Compliance, Sales and Marketing.
• Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Blue KC’s competitive position.
• Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.
• Creates agreements that meet internal operational standards and external provider expectations. Ensures the accurate implementation, and administration through matrix partners.
• Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.
• Manages key provider relationships and is accountable for critical interface with providers and business staff.
• Demonstrates knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
• Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance.
• May provide guidance or expertise to less experienced specialists

Benefits

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
• Annual incentive bonus plan based on company achievement of goals
• Time away from work including paid holidays, paid time off and volunteer time off
• Professional development courses, mentorship opportunities, and tuition reimbursement program
• Paid parental leave and adoption leave with adoption financial assistance
• Employee discount program

What This Job Offers

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