Provider Contracting Specialist, Consultant

Your Role

The Provider Contracting Specialist team are focused on negotiating agreements with a variety of Ancillary Provider Types including clinical laboratories, Home Infusion/ Specialty Pharmacies, and Home/Durable medical Equipment providers. . The Provider Contracting Specialist, Consultants (Network Manager Ancillary and Specialty Networks) will report to the Senior Manager of Provider Contracting. In this role you will be 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 into value-based reimbursement methodologies. This Contract Specialist, Consultant position will also function as a 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.

Your Knowledge and Experience

• Requires a bachelor's degree in business, healthcare policy, public health or related field, or equivalent experience
• Requires at least 7 years provider contracting / negotiation experience including experience managing complex negotiations
• Requires Health care industry/provider network knowledge including data analysis, understanding of provider contract language including provider reimbursement methodologies etc.
• Requires Broad business skills including analysis of strategic alternatives, financial impact analysis and sales experience/exposure
• Requires Strong planning and organizing skills to scope and manage multiple competing priorities
• Requires Ability to support change efforts with cross-functional teams and external partners
• Requires Excellent oral and written communication skills