JOB DESCRIPTION
Your Role

The PPO Professional Provider Contracting team manages our PPO network to maintain network adequacy by contract negotiation, recruitment and building/maintaining professional relationships. The Provider Contracting Specialist, Senior. will report to the Provider Contracting Manager. In this role you will ensure the acquisition, servicing and performance of Physicians/Medical Groups and other Specialty Network Providers to the Blue Shield of CA contracted network. Support attainment of department goals under the leadership of the Director of Provider Contracting and/or Provider Contracting Manager and ensures alignment of these goals with the company’s strategic priorities. Supports review and modification of contracting and cost of health care savings strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches. Research opportunities within the assigned local market (i.e., network expansion opportunities, utilization, or unit cost excesses, etc.) and assesses market trends to drive initiatives which enhance company's market position. Other duties as assigned.

Your Work

In this role, you will:

• Participate in cross-functional team to implement initiatives to help manage the total cost of health care across the assigned region
• Collaborate closely with Medical Management, Provider Relations, Network Analytics and Sales to meet aggressive regional goals
• Drive alignment with Pricing, Underwriting and sales regarding unit cost and other contracting activities
• Identify strategic opportunities within local market (i.e., network expansion opportunities, utilization or unit cost excesses, etc.)
• Assess market trends and competitive benchmarks to enhance company’s market position
• Negotiate and finalize Independent Provider Agreements including value-based payment models for primary care and other specialty network contracts based upon network analysis and established parameters as directed by Director of Provider Contracting and/or Provider Contracting Manager.
• Manage contracting efforts through entire procurement process (end to end) to ensure contracts are administered and implemented accurately.
• Assist with recruitment strategies for targeted providers.
• Collaborate with the contracting leadership team to ensure best practices in negotiations to achieve aggressive unit cost and overall health care cost targets

QUALIFICATIONS
Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 5 years provider contracting / negotiation/ provider relations experience including experience managing complex negotiations
• Strong analytical and problem-solving skills
• Excellent interpersonal, oral and written communication skills
• Health care industry/provider network knowledge including data analysis, understanding of provider contract language including provider reimbursement methodologies etc
• Ability to develop, organize, analyze, and implement processes and procedures
• Broad business skills including analysis of strategic alternatives, financial impact analysis and sales experience/exposure
  

Pay Range:

The pay range for this role is: $ 85360.00 to $ 128040.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – join us!

Our Values:

• Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

From the earliest days of the pandemic, Blue Shield of California has been unyielding in our commitment to putting the health and safety of our people, our members and our communities first. As a health care company, Blue Shield requires all employees to be up to date with COVID-19 vaccination prior to start date as a condition of employment. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date.

The definition of "up to date with your COVID-19 vaccine" is when you have received all doses in the primary series and one booster when eligible. If you are unable to be up to date with your COVID-19 vaccine by your start date, your start date will need to be postponed and you will have 30 days to remedy. If you cannot fulfill the requirement nor obtain an accommodation within 30 days, your offer will be rescinded.