Provider Contracting Specialist
Blue Cross and Blue Shield of Kansas
Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:
Assists in developing the strategic direction and management of the day to day contracting and network management activities for all provider types. Job Description
- Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
- Annual incentive bonus plan based on company achievement of goals
- Time away from work including paid holidays, paid time off and volunteer time off
- Professional development courses, mentorship opportunities, and tuition reimbursement program
- Paid parental leave and adoption leave with adoption financial assistance
- Employee discount program
Assists in developing the strategic direction and management of the day to day contracting and network management activities for all provider types. Job Description
- Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers
- Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.
- Initiates and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Analytics departments, Compliance, Sales and Marketing.
- Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Blue KC's competitive position.
- Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.
- Creates agreements that meet internal operational standards and external provider expectations. Ensures the accurate implementation, and administration through matrix partners.
- Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.
- Manages key provider relationships and is accountable for critical interface with providers and business staff.
- Demonstrates knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
- Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance.
- May provide guidance or expertise to less experienced specialists
- Bachelor's degree in Healthcare Administration, Business, Finance or related field
- Must have three to five years prior managed care or health care reimbursement experience in a health system, consulting firm, or with a managed care payor
- Strong financial analytics and contracting background analyzing healthcare utilization, operational and financial data
- Demonstrated experience with payment methodologies, and network management experience for various provider types
- At least 2-3 years as a Strategic Reimbursement & Contracting Analyst
- Prior experience negotiating contracts
- Extensive knowledge claims processing / billing
- Or any combination of education and experience providing the types and levels of knowledge, skills, and abilities required by the job
- MBA, Master's level degree, or equivalent
- Experience writing and interpreting complex contract language specific to provider reimbursement, including thorough knowledge of managed care contracting and negotiation experience.
Vacancy posted 12 hours ago
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