Provider Contracting Specialist, Consultant (Short Term Employment)

Job Description

Your Role

The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Consultant will report to the Senior Manager of Provider Contracting. In this role you will support Medical Group/IPA and Hospital/Facility contracting in Southern California for all Blue Shield products. You will be responsible for comprehensive management of Medical Group/IPA and Hospital/Facility provider network contract processes including derivation, implementation, and ongoing support of assigned provider agreements. You will support contracting initiatives to drive department objectives to achieve timely contract negotiations and implementation that support growth and maintain strong market position and positive reputation in the market.

***This is a Short-Term Employment position***

Responsibilities

Your Work

In this role, you will:

• 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 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
• Lead 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
• Identify opportunities within the assigned local market (i.e., network expansion opportunities, utilization or unit cost excesses, etc.) and assess market trends to drive initiatives which enhance companies market position
• Support provider contract negotiations by drafting and managing provider contracts in the contract database.
• Ensure the efficient implementation and administration of provider agreements with a primary focus on medical groups/IPA’s hospitals and ASC’s
• Improve and maintain accuracy and integrity of new and existing provider contracts to ensure efficiency in contract administration that will support unit costs savings across all products, while aligning with provider network performance goals and provider engagement strategy
• Interact with multi-disciplinary teams including Law Department, Medical Management, Model Contracts, Provider Relations, Analytics and Sales to implement new or renewing provider contracts and help manage the total cost of healthcare within the assigned region
• Identify opportunities to improve the contract drafting, negotiation, administration, and implementation processes to help drive initiatives that enhance the company’s market position
• Acts as a liaison between Network Management and internal departments and/or external partners.
• Supports company or department projects by researching and providing accurate information as requested by project management teams
• Other duties as assigned
  
  

Qualifications

Your Knowledge and Experience

• Requires a bachelor's degree in business, healthcare policy, public health or related field, or equivalent experience
• Requires at least 7 years provider contracting / negotiation experience including experience managing complex negotiations
• Excellent oral/written, communication and presentation skills, including influence abilities for internal and external discussions
• Effective project management skills and understanding of contract administration and general healthcare reimbursement methodologies and knowledge of healthcare provider networks
• Excellent analytical and problem-solving skills, including knowledge of financial impact analysis
• Experienced in Microsoft Office including, Word, Excel, PowerPoint, and Outlook. Experience working with a contract management system preferred
• Strong organizational skills, detail-orientation and prioritization, and multi-tasking. Flexible with ability to manage multiple tasks efficiently
• Flexible team player who can also work independently
  
  

About The Team

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. 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 achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield isa U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. 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 listen and communicate effectively, showing empathy by understanding others' perspectives.
• 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 and the Ascendiun Family of Companies, 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.