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 Director, Specialty Networks and Vendor Management. This role will support Blue Shield's Behavioral Health and selective Ancillary programs including supporting Plan to Plan, and vendor operations.

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 Facilities
• 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 Director to achieve negotiation results with the most complex providers
• Utilize strong analytical skills and tools to achieve success in negotiation results

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires 7 years of prior relevant experience
• Requires Behavioral Health Facility contracting experience
• Requires at least 5 years of experience in Behavioral Health managed care and Behavioral Health Provider Contracting/Negotiation, including experience managing complex negotiation
• Requires thorough knowledge of the principals of provider relations and operations of Managed Care Commercial, Medicare, and Medi-Cal, contracting
• Requires knowledge of Behavioral Health appeals and grievances
• Requires experience in handling Letters of Agreements with Behavioral Health Providers, and Facilities
• Requires knowledge of monitoring network adequacy and accessibility, per regulatory guidelines

Pay Range:

The pay range for this role is: $109,120.00 to $163,680.00 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.