Senior Provider Contracting Executive

Premera Blue Cross

98d • $95,600 - $162,500

About The Position

The Sr. Provider Network Executive (PNE IV) develops and maintains effective relationships with Premera’s most strategic and complex provider accounts to achieve Premera’s operational and strategic goals, product development strategies, and continuity of Premera’s vision and values. In this highly visible role, the PNE IV is responsible for the negotiation and management of Premera’s most complex and critical provider relationships across the state of Alaska. Success in this position is integral in supporting Premera’s strategy, as well as the implementation of new products through engagement and negotiating with providers to facilitate their support and acceptance of the various strategies and products Premera implements.

Requirements

• Bachelor’s degree or four (4) years of experience in a provider or payer environment.
• Six (6) years of experience in payer or provider contracting and managing provider relationships in the health care or insurance industry to include: Four (4) years of experience negotiating contracts.
• Strong acumen around contract language negotiations.
• Analytical skills.
• Working knowledge of the Health Insurance Portability and Accountability Act (HIPAA), the National Committee for Quality Assurance (NCQA), government health care programs, and risk coding.
• Demonstrated ability to effectively negotiate complex and multi-faceted contracts.
• Working knowledge of complex and alternate funding arrangements and payment methodologies, i.e., gain sharing, risk strategies.
• Demonstrated successful verbal and written communication skills including ability to develop and deliver executive and public presentations, training, and meeting facilitation.
• Knowledge of network development and provider/vendor network recruitment.
• Knowledge of provider community and market anomalies.
• Demonstrated ability to develop and execute strategy.
• Independent work style, self-motivated with ability to lead with minimal direction.
• Strong analytical skills and problem-solving skills.
• Results driven with measurable outcomes.
• Proven ability to lead and direct teams addressing complex issues.
• Strong interpersonal skills coupled with the ability to foster positive working relationships.
• Strong organizational, planning and administrative skills.
• Ability to work under pressure with tight timelines, limited resources, competing priorities and manage project timelines.

Nice To Haves

• Master’s degree in a related field.

Responsibilities

• Develop and execute ongoing account management and service strategies to meet corporate strategic / financial objectives.
• Lead negotiation and implementation of complex, multifaceted provider contracts.
• Complete negotiations within preplanned targets, meet timelines, ensure the established implementation period and perform implementation audits for accuracy of assigned accounts.
• Serve as the main point of contact for the provider and coordinate all Premera interactions with assigned provider accounts.
• Build and maintain positive relationships, generally with the most complex and significant provider/systems.
• Utilize consultative skills, industry knowledge, and Premera product knowledge to foster a collaborative approach to quality care, network stability and cost containment.
• Develop and maintain effective multifaceted and strategic provider networks, with complex payment methodologies and alternate funding arrangements.
• Participate in payment and delivery systems innovation initiatives.
• Monitor and analyze financial and quality metrics to assess effectiveness of networks, reports findings to leadership, and creates action plan.
• Develop strong understanding of providers’ business drivers and performance.
• Collaborate with Healthcare Economics in rate development and proposal analysis.
• Lead a high-level, cross-functional team to provide operationally excellent service and support to strategic accounts.
• Consult and educate assigned account and internal leadership, providing industry and cross-market expertise.
• Create provider specific and public presentations.
• Provide input and/or drive development of payment methodologies and provider engagement strategies.
• Advise Provider Strategy & Solutions (PS&S) leadership and internal stakeholders on account status to facilitate proper internal support of account management efforts to ensure that the resulting final contract supports Premera's operational and strategic goals.
• Engage providers to promote the concept and understanding of patient engagement adherence, cost savings programs.
• Other duties and projects as assigned.

Benefits

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and a pension plan that is vested after 3 years of service.
• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs.
• Generous paid time off to reenergize.
• Tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.
• Commuter perks make your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees