How Is This Role Important to Our Work?

This highly visible position is responsible for negotiating provider contracts by developing provider relationships and negotiating renewals and new contracts with providers. This position coordinates work with provider contract administration, contracts and compliance, credentialing, provider finance and other departments or divisions of Blue Cross. It is critical for this role drive results for the Provider Partner team through closing of contracts and sharing the voice of the provider internally.

A Day in the Life:

• Negotiates provider contracts with some involvement or peers or management as needed.
• Manages the provider relationship, including the strategic direction of the provider and changes in business needs.
• Knows and applies the fundamental concepts, practices and procedures of provider contract negotiation with some involvement of peers or management.
• Manages negotiations against established budget targets and contract negotiations in a timely fashion to meet corporate deadlines.
• Prepares management reports to summarize status, findings and solutions of contract negotiations.
• Investigates complex data in conjunction with network finance or other corporate analysts.
• Interprets contracting and financial data for providers.
• Extensive in-depth knowledge of complex payment methodologies, coding and reimbursement standards, contract language standards, contract compliance issues, claims processing operations, medical management practices, and quality standards and clinical initiatives that impact provider performance.
• Ensures that contracts and payment terms are negotiated in accordance with established contract administration policies and procedures, including regulatory requirements.
• Defines business problems and opportunities for providers and identify strategies and tactics to provide solutions as well as to maximize the value of the provider contract to Blue Cross.
• Works under general guidance, prioritizes and organizes own work to meet deadlines.

Nice to Have:

• Bachelor's degree.
• Displays strong ability to lead cross-functional teams.
• Ability to work across systems and functions to facilitate solutions and capabilities development.
• Demonstrated creativity in solution development with strong sense of urgency.
• Positive thinker/self starter.
• Skillful negotiator, ability to influence internal and external customers.

• 3+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• The position is able to work on multiple priorities, deadlines, and has the ability to adapt to change.
• Excellent communications and interpersonal skills (internal/external).
• Excellent organizational skills.
• MS office applications experience.
• Excellent analytical skills.
• Strong problem resolution skills.
• Ability to develop and perform audit processes.