Provider Contracting Specialist Consultant Blue Shield of California
Overview
The Network Management team leads provider network development and maintenance. This role supports Plan to Plan and vendor operations focusing on large Behavioral Health Groups. You will analyze contracts negotiate agreements and drive cost efficiencies while fostering team growth.
What You'll Do11
- 1Prepare analyze review and project financial impact of large provider contracts
- 2Conduct negotiations and draft individual contracts
- 3Ensure smooth operation and administration of provider agreements
- 4Attain department goals aligned with strategic priorities
- 5Review modify contracting and cost savings strategies
- 6Improve unit costs and maintain competitive rates
- 7Negotiate independently with minimal guidance for complex providers
- 8Utilize analytical tools to achieve successful outcomes
- 9Meet quarterly with top providers to review claims and utilization data
- 10Develop and lead high performing teams through creative critical thinking
- 11Drive continuous learning and professional development
Requirements5
- 1College degree in Business Healthcare Policy Public Health or related field
- 27 years of prior relevant experience in Behavioral Health managed care and provider contracting
- 3Experience handling Letters of Agreements with behavioral health providers and telehealth groups
- 4Thorough knowledge of provider relations and commercial Medicare Medi-Cal contracting
- 5Hybrid workplace model requiring two days in office weekly
Salary Insight
$112 - $167k per year
Location
Required Skills
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