Provider Contract Specialist III - Hybrid

Blue Cross Blue Shield of Arizona; United States; Hybrid; USD 90,000 - 140,000; Full time

Job summary

Blue Cross Blue Shield of Arizona is recruiting for a Network Adequacy and Provider Contracting role within Arizona. The hybrid position negotiates with physicians, hospitals and other providers to establish contracts that support AHCCCS and D-SNP programs.

You will lead large group negotiations, assess financial feasibility, and collaborate with internal teams to implement compliant agreements. The role emphasizes developing partnerships, applying value-based payment methodologies, and driving

Qualifications

• 3 years of experience in healthcare field.
• High-School Diploma or GED required.
• Valid Arizona Driver License with clean record.

Responsibilities

• Identify, recruit, and negotiate contracts with providers such as physicians, behavioral health, facilities and other healthcare provider specialties.
• Lead contracting process and negotiations for large provider groups, hospitals, ACOs, including value-based agreements or alternative payment models.
• Initiate and lead committees or workgroups to identify provider partnerships and other network development strategy.
• Understand and interpret analyses of the financial structure of contracts to meet financial targets.
• Recommend language corrections and changes in contract documents to ease administration and ensure compliance with guidelines.
• Keep informed of new contracting methodologies, contract languages, and systems and manuals.
• Oversee contract setup to ensure accurate claims processing of new and amended contracts.
• Coordinate with internal departments, external Blue Plans or partners, providers, and government agencies as a representative of the contracting team.
• The position requires a full-time work schedule (40 hours/week) plus additional hours as needed.
• Perform all other duties as assigned.

Skills

Healthcare experience

Contract negotiations

Provider contracts

Regulatory compliance

Data analysis

Stakeholder management

Education

High-School Diploma or GED

Job description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month Onsite: daily onsite requirement based on the essential functions of the job Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

Purpose of the job

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 Minimum 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 Qualifications

• 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 andhospitals (Applies to Levels 2 - 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.

For more information on our company, see azblue.com.

Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross BlueShield of Arizona