Provider Contracting Specialist, Consultant

Blue Shield of CA; Long Beach (CA); Hybrid; USD 120,000 - 170,000; Full time

Job summary

Blue Shield of CA is seeking a Provider Contracting Specialist, Consultant to independently manage a portfolio of provider negotiations and contracting initiatives across California. You will execute strategic negotiations, analyze financial impact, and ensure alignment with statewide contracting strategies and approvals.

You will collaborate across the organization to advance affordability, network access, and business objectives while meeting policy and control requirements, and you will

Qualifications

• Bachelor's degree or HS Diploma with 4 years of relevant experience required.
• Experience in provider contracting and negotiation, including complex negotiations preferred.
• Advanced knowledge of provider contracting and reimbursement methodologies preferred.
• Understanding managed care operations and implications of provider agreements preferred.

Responsibilities

• Manage complex provider negotiations and contracting initiatives from analysis to execution.
• Collaborate across the organization to align with contracting strategies and approval requirements.
• Identify risks and escalate matters requiring policy, resources, or executive decisions.

Skills

Provider contracting

Negotiation

Data interpretation

Portfolio management

Education

Bachelor's degree or HS Diploma

Job description

Your Role

The Provider Network Management team is responsible for provider contracting and network performance across California. The Provider Contracting Specialist, Consultant is accountable for executing an assigned portfolio of provider negotiations and contracting initiatives within the statewide strategies, governance standards, priorities, and escalation framework established by contracting leadership.

In this role, you will independently manage complex provider negotiations and contracting initiatives from strategic and financial analysis through execution, implementation, and issue resolution. You will partner across the organization to advance affordability, network access, and business objectives while ensuring work is executed within established contracting strategies, policies, controls, and approval requirements. You will be accountable for the timely execution and performance of your assigned portfolio, proactively identifying risks and escalating matters requiring broader policy, resource, or executive decisions.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree required
• 7 years of prior relevant experience required
  Previous experience with provider contracting and negotiation experience, including experience managing complex negotiations and provider contracting processes preferred
• Advanced working knowledge of provider contracting, reimbursement methodologies, provider contract language, financial impact analysis, and provider network management preferred
• Working knowledge of managed care operations and the financial, operational, legal, regulatory, and member implications of provider agreements preferred
• Demonstrated ability to interpret data, evaluate alternatives, develop negotiation strategies, and translate analysis into practical recommendations preferred
• Strong project and portfolio-management skills, including the ability to manage multiple negotiations, milestones, dependencies, and competing priorities preferred

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.