Provider Contracting Specialist, Consultant

Your Role

The Network Management team is responsible for the development and maintenance of all provider networks, including vendor and Plan to Plan relationship necessary to provide our members and clients with access to quality, affordable health care services. The Provider Contracting Specialist, Consultant will report to the Senior Manager, Specialty Networks and Vendor Management. This role will support Blue Shield of California's (BSC's) Behavioral Health and selective Ancillary programs including supporting Plan to Plan, and vendor operations.

Your Knowledge and Experience

• Requires a college degree in Business, Healthcare Policy, Public Health, or related field, or equivalent experience
• Requires 7 years of prior relevant experience. A minimum of 3 years of experience in Behavioral Health managed care and Behavioral Health Provider Contracting/Negotiation (including experience managing complex negotiation) is preferred
• Requires Behavioral Provider contracting experience
• Thorough knowledge of the principals of provider relations and operations of Managed Care Commercial, Medicare, and Medi-Cal contracting
• Knowledge of Behavioral Health appeals and grievances
• Expertise in claims processing and contract pricing validations
• Experience in handling LOAs with Behavioral Health Providers, Facilities and Telehealth Groups