Sr Provider Contract Analyst

Blue Cross and Blue Shield of North Carolina; Durham (CA); Hybrid; USD 89,000 - 143,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Parental leave

Tuition reimbursement

401k match

Job summary

Blue Cross NC in Durham is seeking a Senior Provider Contract Analyst to lead assessment, negotiation, and management of complex provider reimbursement initiatives and contracts with academic medical centers and multispecialty groups.

The role offers a hybrid work model with remote flexibility and in-person collaboration; you will coordinate with internal stakeholders, develop innovative contracting strategies, and forecast financial and quality impacts to strengthen the provider network.

Qualifications

• Bachelor's degree or advanced degree (where required).
• 5+ years of experience in related field.
• In lieu of degree, 7+ years of experience in related field.

Responsibilities

• Research, analyze, develop, and negotiate provider network strategies.
• Coordinate resources to implement strategic network initiatives.
• Provide input in discussions with internal and external stakeholders to ensure Network Management input.
• Facilitate next generation, innovative global provider network opportunities and negotiate contracts.
• Develop feasibility models and forecast performance impact of contracting strategies.
• Participate in direct provider negotiations with academic medical centers and multispecialty providers.
• Coordinate with stakeholders to ensure capabilities for contract and service implementations.

Skills

5+ years experience

Experience in related field

Education

Bachelor's degree or advanced degree

In lieu of degree, 7+ years experience

Job description

Job Description

We're hiring a Senior Provider Contract Analyst who will be responsible for the assessment, development, articulation, negotiation, implementation and management of complex enterprise and divisional innovative provider reimbursement initiatives to be implemented with healthcare providers and integrated healthcare delivery systems. You will also manage contracting with assigned systems to ensure Blue Cross NC holds a leading provider network capability position in the provider network dimension.

What You'll Do

• Responsible for research, analysis, development, implementation and negotiation of innovative provider network strategies, including:
  • Value based, shared risk arrangements
  • Long-Term Strategic Contracting Initiatives
  • Reducing Cost of Care
  • Improving Quality of Care
  • Provider Incentive Programs
  • Contract Administration Improvements
• Coordinate with all internal stakeholders to ensure the assignment of resources (FTEs, Technology, etc.) necessary to successfully implement the strategic network initiatives.
• Provide expertise in select internal and external (BCBSA, vendors, etc.) discussions regarding network strategies to ensure Network Management has direct input into these initiatives, and establish consistency within Blue Cross NC and (where feasible) among other Blues Plans.
• Accountable for facilitating next generation, innovative global provider network opportunities, recommending strategies, gaining Plan approval for select provider strategies, implementing through negotiations those strategies into provider contracts, and ensuring effective use of Plan resources to administer approved strategies.
• Contribute to the development of feasibility models and forecasting the performance impact of the innovative contracting strategies.
• Participate in direct provider negotiations with key providers, such as academic medical centers and multispecialty professional providers.
• Connect with Network Management and other internal stakeholders to ensure operational and administrative capabilities are established to implement contract and service strategies.

What You Bring

• Bachelor's degree or advanced degree (where required)
• 5+ years of experience in related field.
• In lieu of degree, 7+ years of experience in related field.

What You'll Get

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution

Where You'll Work

Our Hybrid-Flex approach is built on presence with a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplace that’s flexible, connected, and future focused. In a Hybrid-Flex role, you'll work in the office at least two days a week for collaboration and connection. In a Remote-Flex role, you'll work virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid-Flex or Remote-Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$89,174.00 - $142,679.00

Skills

Complex Project Management, Contracting Strategies, Contract Management, Contract Negotiations, Health Care, Healthcare Contracts, Healthcare Networks, Health Care Quality Improvement, Network Development, People Management, Project Management, Provider Contracts, Provider Network Management, Resource Allocation, Resource Management, Vendor Relationships

_____________________________________________________________________