Provider Contracting Specialist

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:

• 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

Job Description Summary:

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

Minimum Qualifications

• 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

Preferred Qualifications

• 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.

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

Originally posted on Himalayas