Principal Provider Contract Analyst

NC Health Affiliates; United States; On-site; USD 130,000 - 170,000; Full time

Job summary

NC Health Affiliates seeks a Principal Provider Contract Analyst to lead end-to-end provider contracting lifecycle with major health systems and provider organizations. The role acts as the quarterback for coordination between provider partners and Blue Cross NC, guiding complex negotiations and strategic initiatives to advance organizational priorities.

The ideal candidate has extensive experience in provider contracting, network strategy, and performance improvement, with a strong ability to

Qualifications

• Bachelor's degree or advanced degree required.
• 8+ years of experience in related field; 10+ years in lieu of degree.
• Healthcare provider contracting, network management, or managed care experience is a plus.

Responsibilities

• Manage executive-level relationships with health systems and provider organizations.
• Serve as primary point of accountability for complex provider issues.
• Lead development, negotiation, implementation, and management of complex provider contracts and reimbursement arrangements.
• Lead cross-functional discussions to allocate resources for provider issues and Plan initiatives.
• Coordinate provider engagement activities and ensure educational needs are met.
• Lead provider meetings and executive touchpoints with agenda, facilitation, and follow-up.
• Develop business cases, financial analyses, and forecasting for contract opportunities.
• Monitor provider performance to improve quality, affordability, and value-based care outcomes.

Skills

Executive relationships

Negotiation

Financial analysis

Education

Bachelor's degree or higher

Job description

Job Description

This position serves as the provider account executive for the Plan's largest and most strategically important healthcare delivery systems and provider organizations. This role serves as the "quarterback" and central point of coordination and integration between key provider partners and Blue Cross NC. In this highly visible role, the incumbent cultivates trusted partnerships with provider executives, leads complex negotiations, is accountable for resolving complex provider issues, and influences strategic initiatives that advance organizational priorities.

The Principal Provider Contract Analyst is responsible for the end-to-end provider contracting lifecycle, including network strategy development, reimbursement innovation, provider engagement, contract negotiation, implementation, performance management, and compliance oversight. As a strategic advisor and subject matter expert, the incumbent leads cross-functional workgroups and initiatives that drive innovative provider strategies, support value-based care initiatives, improve affordability and quality outcomes, and strengthen provider partnerships that enhance Blue Cross NC's competitive position in the marketplace.

What You'll Do

• Manage executive-level relationships with assigned health systems and provider organizations, fostering strategic partnerships that support a collaborative approach to quality care, network development and stability, affordability, and identification and resolution to barriers for success
• Serves as primary point of accountability for complex and escalated provider issues, facilitating timely resolution through collaboration with internal and external stakeholders
• Lead the development, negotiation, implementation, and ongoing management of complex provider contracts and reimbursement arrangements, including: Lead the development, negotiation, implementation, and ongoing management of complex provider contracts and reimbursement arrangements, including:
• Value based, shared risk arrangements
• Strategic network and contracting initiatives
• Cost of Care management strategies
• Quality and Performance improvement programs
• Product strategy and competitive positioning
• Provider Incentive Programs
• Contract administration and operational enhancements
• Lead cross-functional teams and stakeholders discussions to ensure resources are assigned to address provider issues and concerns, as well as support the advancement of strategic Plan initiatives. Provide direct input on initiatives and serve as the subject-matter expert for assigned providers regarding contract and relationship status, trends, innovation, and emerging opportunity
• Partner closely with the assigned strategic relationship support analyst to coordinate provider engagement activities, ensure provider educational needs are met, and proactively identify, resolve and track organizational issues
• In collaboration with the strategic relationship support analyst, jointly lead provider meetings and executive touchpoints, including agenda development, facilitation, capture action items, meeting documentation and follow-up accountability
• Develop business cases, financial analyses, feasibility assessments, and forecasting models to evaluate contract opportunities, reimbursement strategies, and innovative provider arrangements
• Monitor provider performance and support initiatives that improve quality, affordability, member experience, and value-based care outcomes.

Limited travel is required within the state of NC. Candidates for this role must live in NC. Onsite expectations will be discussed during the interview process.

What You Need

• Bachelor's degree or advanced degree (where required)
• 8+ years of experience in related field.
• In lieu of degree, 10+ years of experience in related field.

Bonus Points

• Proven experience in healthcare provider contracting, network management, provider relations, or managed care experience, including accountability for large health systems and strategically significant provider organizations.
• Demonstrated success leading complex provider contract negotiations, including value-based care arrangements, risk-sharing models, alternative payment methodologies, and reimbursement innovation.
• Proven ability to build and maintain executive-level relationships with health system executives, physician leaders, and other senior healthcare stakeholders
• Experience leading cross-functional strategic initiatives involving network strategy, finance, actuarial, clinical, operations, legal, and product teams to achieve organizational objectives
• Strong financial and analytical acumen, including provider economics, contract modeling, forecasting, performance analysis, and cost of care management.
• Knowledge of healthcare reimbursement methodologies, value-based care principles, regulatory requirements, and healthcare market dynamics, with the ability to translate insights into actionable business strategies .

What You'll Get

The opportunity to work at the cut