Provider Contract Specialist III - Hybrid

Network Adequacy and Sufficiency

Network adequacy and sufficiency, negotiates and contracts with healthcare providers (such as physicians, behavioral health, ancillary providers, and hospitals) for Arizona Medicaid (AHCCCS) and Dual Eligible Special Needs Plan (D-SNP) business segments, including incorporating value-based payment methodologies into agreements as available and applicable.

Qualifications

Required Work Experience

• 3 years of experience in Healthcare field (Applies to All Levels)

Required Education

• High-School Diploma or GED in field of study (Applies to All Levels)

Required Licenses

• Valid Arizona Driver License, with an acceptable driving record (Applies to All Levels)

Required Certifications

• N/A

Preferred Work Experience

• 5+ years of experience in provider contract negotiations, contract analysis and modeling, alternative payment methodologies, centers of excellence or equivalent experience in healthcare field.

Preferred Education

• Undergraduate degree in Business Administration, Healthcare Administration or equivalent experience in Medicaid or Medicare such as practice administration, provider, or members services, claims and encounters

Preferred Licenses

• N/A

Preferred Certifications

• N/A

Essential Job Functions and Responsibilities

• Identify, recruit, and negotiate contracts with various types of providers such as physicians, behavioral health, ancillary providers, facilities (Hospitals/Skilled Nursing) and other healthcare provider specialties.
• Lead contracting process and negotiations for large provider groups, hospitals, ACOs, including value-based agreements or alternative payment models (Level 2-3).
• Initiate and lead committees or workgroups to identify provider partnerships and other network development strategy (Level 2-3).
• Understand and interpret various analyses of the financial structure of contracts to ensure it meets financial targets.
• Recommend language corrections and changes in contract documents to allow for easier administration and ensure compliance with corporate and regulatory guidelines.
• Keep informed of new or updated contracting methodologies, contract languages, and contracting systems, procedures, forms, and manuals.
• Oversee contract setup to ensure accurate claims processing of new and amended contracts.
• Consult and coordinate with various internal departments, external Blue Plans or business partners, providers, business entities, and government agencies as a representative of the contracting team.
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform all other duties as assigned.

Competencies

Required Minimum Competencies

Required Job Skills

• Intermediate-Advanced PC proficiency and office equipment skills (Applies to All Levels)
• Intermediate-Advanced skill in word processing, spreadsheet, and database software (Applies to All Levels)

Required Professional Competencies

• Ability to present and interact at a professional level (Applies to All Levels)
• Ability to negotiate contract terms and conditions (Applies to All Levels)
• Maintain confidentiality and privacy (Applies to All Levels)
• Ability to prioritize and manage work assignments and work independently (Applies to All Levels)

• Knowledge necessary to analyze reports based on available data and then make decisions based on reported data (Applies to All Levels)
• Capable of investigative and analytical research (Applies to All Levels)
• Establish and maintain working relationships in a collaborative team environment (Applies to All Levels)
• Identify root causes and initiate solutions (Applies to All Levels)
• Proven track record negotiating large provider groups, ancillary providers and hospitals (Applies to Levels 2 - 3)

Required Leadership Experience and Competencies

• Demonstrated leadership experience (Applies to Level 3)
• Mentor and train entry level staff and teammates (Applies to Level 3)

Preferred Competencies

Preferred Job Skills

• Familiarity with SharePoint, DocuSign, Power BI/Tableau, automated workflow applications

Preferred Professional Competencies

• Knowledge of provider reimbursement methodologies contracts and networks (Applies to All Levels)

Preferred Leadership Experience and Competencies

• Ability to positively influence others (Applies to Level 3)
• Considered role model for co-workers (Applies to Level 3)

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

Blue Cross Blue Shield of Arizona