Blue Shield Of California
Provider Contracting Specialist, Consultant
Blue Shield Of California, Oakland, California, United States, 94616
Job Description
Your Role
The Network Management team is responsible for the development and maintenance of all provider networks, including vendor and Plan to Plan relationship necessary to provide our members and clients with access to quality, affordable health care services. The Provider Contracting Specialist, Consultant will report to the Program Manager, Principal. This role will support Blue Shield of California's Behavioral Health including Applied Behavioral Analysis (ABA) and selective Ancillary programs including supporting Plan to Plan, and vendor operations.
Responsibilities
Your 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. The primary focus will be on large Behavioral Health Groups and Behavioral Health Providers 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 Program Manager, Principal to achieve negotiation results with the most complex providers Utilize strong analytical skills and tools to achieve success in negotiation results Qualifications
Your 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 Requires Behavioral Health Provider contracting experience A minimum of 3 years of experience in Behavioral Health managed care and Behavioral Health Provider Contracting/Negotiation, including experience managing ABA complex negotiation is preferred Experience in handling Letters of Agreements with Behavioral Health Providers, ABA and Telehealth Groups Thorough knowledge of the principals of provider relations and operations of Managed Care Commercial, Medicare, and Medi-Cal contracting Knowledge of Behavioral Health appeals and grievances Pay Range:
The pay range for this role is: $109,340.00 to $164,120.00 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.
#LI-JS3
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 genuinely 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 continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - 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. Our Workplace Model:
At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
Hybrid (Default):
Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions: Member-facing and approved out-of-state roles remain remote. Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits. 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.
On-Site:
Work from a business unit-approved
office
an average of four (4) or more days a week.
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.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
Your Role
The Network Management team is responsible for the development and maintenance of all provider networks, including vendor and Plan to Plan relationship necessary to provide our members and clients with access to quality, affordable health care services. The Provider Contracting Specialist, Consultant will report to the Program Manager, Principal. This role will support Blue Shield of California's Behavioral Health including Applied Behavioral Analysis (ABA) and selective Ancillary programs including supporting Plan to Plan, and vendor operations.
Responsibilities
Your 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. The primary focus will be on large Behavioral Health Groups and Behavioral Health Providers 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 Program Manager, Principal to achieve negotiation results with the most complex providers Utilize strong analytical skills and tools to achieve success in negotiation results Qualifications
Your 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 Requires Behavioral Health Provider contracting experience A minimum of 3 years of experience in Behavioral Health managed care and Behavioral Health Provider Contracting/Negotiation, including experience managing ABA complex negotiation is preferred Experience in handling Letters of Agreements with Behavioral Health Providers, ABA and Telehealth Groups Thorough knowledge of the principals of provider relations and operations of Managed Care Commercial, Medicare, and Medi-Cal contracting Knowledge of Behavioral Health appeals and grievances Pay Range:
The pay range for this role is: $109,340.00 to $164,120.00 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.
#LI-JS3
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 genuinely 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 continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - 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. Our Workplace Model:
At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
Hybrid (Default):
Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions: Member-facing and approved out-of-state roles remain remote. Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits. 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.
On-Site:
Work from a business unit-approved
office
an average of four (4) or more days a week.
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.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.