Hybrid Provider Contracts Lead

Blue Cross Blue Shield of Arizona; Phoenix (AZ); Vor Ort; USD 85.000 - 110.000; Vollzeit

Zusammenfassung

Blue Cross Blue Shield of Arizona is seeking a Network Adequacy professional to negotiate contracts with physicians, hospitals and other providers across the Arizona healthcare network. This role will lead large group negotiations, drive value-based arrangements, and oversee contract setup to ensure compliant claims processing.

The position requires 3 years in healthcare plus a valid AZ driver license and a strong background in contract analysis, modeling and favorable payment methodologies.

Qualifikationen

• 3 years of experience in Healthcare field.
• High-School Diploma or GED in field of study.
• Valid Arizona Driver License, with an acceptable driving record.
• N/A
• 5+ years of experience in provider contract negotiations, contract analysis and modeling, alternative payment methodologies, centers of excellence or equivalent experience in healthcare field.
• 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

Aufgaben

• 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.

Kenntnisse

Contract negotiation

Data analysis

Communication

Time management

PC proficiency

Word processing

Spreadsheets

Databases

Confidentiality

Professional competencies

Ausbildung

High-School Diploma or GED

Undergraduate degree in Business Administration or Healthcare Administration

Tools

SharePoint

DocuSign

Power BI

Tableau

Automated workflow tools

Jobbeschreibung

Blue Cross Blue Shield of Arizona is seeking a Network Adequacy professional to negotiate contracts with physicians, hospitals and other providers across the Arizona healthcare network. This role will lead large group negotiations, drive value-based arrangements, and oversee contract setup to ensure compliant claims processing.

The position requires 3 years in healthcare plus a valid AZ driver license and a strong background in contract analysis, modeling and favorable payment methodologies.