Job DescriptionYour Role The Network Management team is responsible for the development and maintenance of all provider networks, including vendor and Plan to Plan relationships necessary to provide our members and clients with access to quality, affordable healthcare services. The Provider Contracting Specialist, Consultant will report to the Manager, Specialty Networks and Vendor Management. In this role, you will support Blue Shield of California's Behavioral Health and selective Ancillary programs including supporting Plan to Plan, and vendor operations. The primary focus will be on large Behavioral Health Groups and Providers.
ResponsibilitiesYour Work In this role, you will:
- Prepare, analyze, review, and project financial impact of large or complex provider contracts and alternate contract terms
- Conduct negotiations and draft individual contracts
- Ensure the smooth operation and administration of provider agreements
- Attain department goals under the leadership of the Director of Specialty Networks and Vendor Management, and ensure alignment of these goals with the company's broader strategic priorities
- Continually review and modify contracting and cost of health care savings strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches
- Improve and maintain highly competitive unit costs across all products and in doing so will ensure that a superior provider network is available
- Negotiate independently with minimal guidance from the manager to achieve negotiation results with the most complex providers
- Utilize strong analytical skills and tools to achieve success in negotiation results
- Meet quarterly with top providers to review claims and utilization data.
QualificationsYour Knowledge and Experience - Requires a college degree in Business, Healthcare Policy, Public Health, or related field or equivalent experience
- Requires 7 years of prior relevant experience in Behavioral Health (BH) managed care and BH Provider Contracting/Negotiation, including managing complex provider negotiations
- Experience handling Letters of Agreements with behavioral health providers and telehealth groups is preferred
- Thorough knowledge of the principles of provider relations and operations of managed care commercial, Medicare, and Medi-Cal contracting
- Knowledge of behavioral health appeals and grievances
HybridThis role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Our Workplace Model We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
- For most teams, this means coming into the office two days per week.
- Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
- For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
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.
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