Specialist, Provider Contract

Summary Responsible for the establishment and maintenance of financial systems for various provider networks. Solicits/contracts with providers and negotiates pricing during initial and contract renewals. Interfaces with various health plans to resolve problems with contracts, reimbursement methodologies, and claims adjudication. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Description Logistics: BlueCross BlueShield of South Carolina - About Us​ | BlueCross BlueShield of South Carolina Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is remote W@H South Carolina. What You’ll Do: • Conducts initial/renewal contract negotiations with providers (hospitals, surgery centers, skilled nursing facilities, radiological providers, independent labs, home health agencies, DME suppliers, pharmacies, etc.) to obtain price concessions and establish provider networks that give the company a competitive advantage. • Interacts/works with providers, government agencies, and internal departments to ensure contract compliance. Resolves problems with provider contracts, reimbursement methodologies, benefit structures, and administrative/medical policy issues. • Prepares/interprets data analysis to determine impact of various pricing decisions related to payment rates and methods negotiated with providers. • Maintains knowledge of department procedures, current/proposed government regulations, and state/federal laws related to provider contracting and health care delivery. • Provides direction/guidance/training to staff. Assists with project planning, work assignments, and development of work procedures. To Qualify for This Position, You’ll Need the Following: • Required Education: Bachelor's • Required Work Experience: 3 Years Healthcare and/or managed care contracting, with 2 of the 3 in managed care contracting. We Prefer That You Have the Following: • Preferred Skills and Abilities: Previous contracting and negotiation experience Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. • Subsidized health plans, dental and vision coverage • 401k retirement savings plan with company match • Life Insurance • Paid Time Off (PTO) • On-site cafeterias and fitness centers in major locations • Education Assistance • Service Recognition • National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. 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