Provider Contract Specialist (Provider contracting experience required)
Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.
Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering 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.
Negotiates and contracts with healthcare providers ( mostly physicians and ancillary providers) for all business segments, including incorporating value based payment methodologies into agreements as available and applicable
- Using strong negotiation skills, contract with healthcare providers or their designated consultant to meet targeted goals for both fee for service and value based agreements leveraging all business segments.
- Understand and interpret various analyses of the financial structure of contracts to ensure it meets financial targets.
- Work closely with Legal to ensure that contract language can be administered and compliant with corporate guidelines.
- Keep informed of new or updated contracting methodologies, contract languages, and contracting systems, procedures, forms and manuals through staff meetings and verbal and written communications.
- Update and maintain contracting documents, ensuring compliance with legal, regulatory and compliance guidelines.
- 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.
- Identify, research, process, resolve and respond to provider contracting inquiries and correspondence via telephone, written communication and/or in person.
- Monitor and communicate compliance status of contractual requirements to Provider Relationship staff ensuring consistent communication.
- The position requires the PCS to attend monthly onsite staff meetings and other meetings in person, as required.
- 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.
Required Work Experience
- 1 year of experience in Healthcare field (Applies to All Levels)
- High-School Diploma or GED in field of study (Applies to All Levels)
- Valid Arizona Driver License, with an acceptable driving record (Applies to All Levels )
Preferred Work Experience
- 2 years of experience in healthcare field, working with providers (Applies to All Levels)
- Associate's Degree in field of study (Applies to All Levels)
- Intermediate PC proficiency (Applies to All Levels)
- Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (Applies to All Levels)
- Intermediate skill in word processing, spreadsheet and database software (Applies to All Levels)
- 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)
- Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards (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)
- Ability to manage multiple large provider groups/hospitals (Applies to Levels 2 - 3)
- Ability to train entry level staff (Applies to Levels 2 - 3 )
- Ability to communicate complex provider issues effectively (Applies to Levels 2 - 3 )
- Strong negotiating skills and presentation of details (Applies to Levels 2 - 3)
- Ability to manage high-level projects with minimal supervision (Applies to Level 3)
- Ability to demonstrate diplomacy in all situations (Applies to Level 3)
- Ability to negotiate and present independently (Applies to Level 3)
- Proven track record of negotiating difficult contracts to meet targeted goals. (Applies to Level 3)
- Exhibit strong leadership skills (Applies to Level 3)
- Mentor and guide co-workers (Applies to Level 3)
BCBSAZ 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.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.
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