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. Primary focus on medical groups/IPA's and hospitals
Attain department goals under the leadership of the Director of Provider Contracting and ensures alignment of these goals with the company's broader strategic priorities.
Continually reviews and modifies contracting and cost of health care savings strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches.
Improves and maintains highly competitive unit costs across all products and in doing so ensures that a superior provider network is available to all employer groups.
Negotiates independently with minimal guidance from the Director to achieve negotiation results with the most complex providers.
Utilizes strong analytical skills and tools to achieve success in negotiation results.
Leads multi-disciplinary teams including Medical Management, Provider Relations, Analytics and Sales to implement a new regional structure and help manage the total cost of healthcare within the assigned region.
Identifies 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 companies market position.
Other duties as assigned.
5-7 years provider contracting / negotiation experience including experience managing complex negotiations with a Bachelor's degree in Business, Healthcare Policy, Public Health or related field.
Excellent oral/written, communication and presentation skills, including influence abilities for internal and external discussions
Effective negotiation skills and understanding of fee-for-service hospital and capitated reimbursement methodologies (including knowledge of DOFRs) and provider network analysis
Effective in balancing multiple negotiations and projects with successful outcomes while meeting tight timelines
Strong planning and organizational skills
Excellent analytical and problem-solving skills, including knowledge of financial impact analysis.
Office Environment - full time schedule in Woodland Hills Office.
Blue Shield Of California