Provider Contracting Specialist, Principal

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. We’re excited to share Blue Shield of California has received awards and recognition for â€" LGBT diversity, quality improvement, most influential women in corporate America, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we’re striving to make a positive change across our industry and the communities we live in â€" Join us!

Description

Job Summary

Provider Contracting Specialist - Prepares, analyzes, reviews, and projects financial impact of large or complex provider contracts and alternate contract terms. Conducts negotiations and drafts individual contracts. Ensures the smooth operation and administration of provider agreements. Focus on either 1) medical groups/IPA's, hospitals, Skilled Nursing Facilities and freestanding surgery centers, or 2) PPO and Specialty Benefits. In addition, supports Regional Strategy.

Responsibilities
  • Oversees an annual spend of nearly $80M - $400M.
  • Participates in cross-functional team to implement initiatives to help manage the total cost of health care across the assigned region
  • Collaborates closely with
  • Medical Management,
  • Provider Relations, Network Analytics and Sales to meet aggressive regional goals.
  • Drives alignment with Pricing, Underwriting and sales regarding unit cost and other contracting activities.
  • Identifies strategic opportunities within local market (i.e., network expansion opportunities, utilization or unit cost excesses, etc.).
  • Assesses market trends and competitive benchmarks to enhance company's market position.
  • Other duties as assigned.




Qualifications

Knowledge and Experience
  • 7-10 years provider contracting experience with a Bachelors degree in Business, Healthcare Policy, Public Health or related field or 6 years and a Master's degree; or a PhD with 3 years of experience.
  • Substantial experience in managing complex and high-profile provider negotiations.
  • Requires mastery level knowledge of job area typically obtained through advanced education combined with experience.




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.


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.EEO Policy