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Provider Contracting Specialist, Consultant at Blue Shield of CA

Posted in Other 30+ days ago.

Location: WOODLAND HILLS, California





Job Description:








Job Summary

The Provider Contracting Specialist, Consultant - Network Manager Ancillary and Specialty Network position is focused on negotiating agreements with a variety of Ancillary Provider Types including clinical laboratories, Home Infusion/ Specialty Pharmacies, and Home/Durable medical Equipment providers. In addition, this position is responsible for driving strategies to reduce the Cost of Healthcare, improve quality outcomes, and broaden our networks to include Medi Cal, Medicare, and BSC Tandem/ High Performing Networks Lines of Business throughout the state of California. The Contract Specialists Consultant positions also play major roles in our Network Strategy to transform reimbursement methodologies to value based reimbursement methodologies . This Contract Specialist ,Consultant positions will also function as Subject Matter Experts on the networks the positions are responsible for, supporting other Blue Shield of Ca depts such as Legal, medical and Provider Operation, etc.

The Provider Contracting Specialist, Consultants will be members of a high performing team responsible for assigned regional service area in managing & maintaining California's largest PPO physician network, to support our 4.6 million HMO and PPO members with over $2.0 billion in annual spend.

Responsibilities


  • Helps execute unit cost trend targets and specific metric improvement for providers within assigned regions to constantly improve overall competitive position.

  • Working closely with the contracting leadership team to ensure best practices in negotiations in order to achieve aggressive unit cost and overall health care cost targets.

  • Assigned Initiatives representing an additional $5 - $10M in annual cost.

  • Helps implement department goals under the leadership of the Sr. Manager of Ancillary and Specialty Networks and ensures alignment of these goals with the company's broader strategic priorities.

  • Continually review and modify contracting strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches as well as shifts in product design and / or market opportunities.

  • Assigned SME role that requires leading the contracting team members in implementing, communicating and executing with internal and external teams.

  • Improves and maintains highly competitive unit costs across all products for assigned service area and in doing so will ensure that a high performing provider network is available to all employer groups.

  • Helps implement department goals under the leadership of the Contracting Executives and ensures alignment of these goals with the company's broader strategic priorities.








Knowledge & Experience


  • 5-7 years provider contracting / negotiation experience including experience managing complex negotiations with a Bachelors degree in Business, Healthcare Policy, Public Health or related field.

  • Excellent analytical and problem-solving skills.

  • Requires deep knowledge of job area typically obtained through advanced education combined with experience.

  • Typically, viewed as a specialist within discipline.

















Additional Information







  • About Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. Weare excited to share Blue Shield of California has received awards and recognition for a" LGBT diversity, quality improvement, most influential women in corporate America, Bay Areaas top companies in volunteering & giving, and one of the worldas most ethical companies. Here at Blue Shield of California, weare striving to make a positive change across our industry and the communities we live in a" Join us!






  • Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
    Please click here for further physical requirement detail.










  • EEO Footer: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.





  • Requisition ID: 210022B







  • Posting Date: Jul 24, 2021





  • Schedule: Full-time











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