Specialist, Provider Contract

BlueCross BlueShield of South Carolina

75d

About The Position

Responsible for the establishment and maintenance of financial systems for various provider networks. Solicits/contracts with providers and negotiates pricing during initial and contract renewals. Interfaces with various health plans to resolve problems with contracts, reimbursement methodologies, and claims adjudication.

Requirements

• Bachelor's degree required.
• 3 years of healthcare and/or managed care contracting experience, with 2 of the 3 years in managed care contracting.

Nice To Haves

• Previous contracting and negotiation experience.

Responsibilities

• Conducts initial/renewal contract negotiations with providers (hospitals, surgery centers, skilled nursing facilities, radiological providers, independent labs, home health agencies, DME suppliers, pharmacies, etc.) to obtain price concessions and establish provider networks that give the company a competitive advantage.
• Interacts/works with providers, government agencies, and internal departments to ensure contract compliance.
• Resolves problems with provider contracts, reimbursement methodologies, benefit structures, and administrative/medical policy issues.
• Prepares/interprets data analysis to determine impact of various pricing decisions related to payment rates and methods negotiated with providers.
• Maintains knowledge of department procedures, current/proposed government regulations, and state/federal laws related to provider contracting and health care delivery.
• Provides direction/guidance/training to staff.
• Assists with project planning, work assignments, and development of work procedures.

Benefits

• Subsidized health plans, dental and vision coverage.
• 401k retirement savings plan with company match.
• Life Insurance.
• Paid Time Off (PTO).
• On-site cafeterias and fitness centers in major locations.
• Education Assistance.
• Service Recognition.
• National discounts to movies, theaters, zoos, theme parks and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees