Maryland Staffing
Provider Contracting Specialist (Remote)
Maryland Staffing, New York, New York, United States
Job Title
This role will lead, guide, strategize and manage negotiations for provider-specific institutional, ancillary, and professional contracts. Key responsibilities include negotiating contract terms in accordance with regulatory requirements, analyzing financial data to evaluate implications across various business lines, while ensuring compliance with company policies and procedures, and coordinating with the Payment Transformation team to transition fee-for-service arrangements to value-based care. This role will also oversee complex projects related to provider contracts, reimbursement methods, documentation and amendments, and participate in internal workgroups and committees, ensuring compliance and advising on business strategies. We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. Essential Functions
Contract Development and Negotiation Research and Data Analysis Recruitment and Relationship Regulatory and Healthcare Landscape Administration Qualifications
Education Level: Bachelor's Degree in Business Administration, Healthcare, Public Health, Finance or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Experience: 2 years healthcare, business or related field. 1 year experience in contracting, provider recruitment or provider relations. Preferred Qualifications: Masters degree in Business or Healthcare Administration. Knowledge of healthcare or health insurance payor industry (Medicare, Medicaid, Commercial, DSNP and other payor programs), including legal and regulatory requirements. Solid understanding of CPT-4, HCPCS, revenue and ICD coding, medical terminology, claims payment, contract negotiations and problem resolution. Knowledge, Skills and Abilities (KSAs): Understanding of multiple reimbursement methodologies used in healthcare provider contracting, including third party payment methodologies, delegated arrangements and payor networks (PPO, HMO, value-based contracting, etc.). Effective time and project management skills to be able to plan and monitor activities to ensure achievement of organizational goals. Strong interpersonal skills to effectively interface with all levels of staff, providers, vendors, and business-related associates. Ability to lead project teams towards goal attainment and work independently or as part of a team. Strong analytical, problem-solving and critical thinking skills, with the ability to use reason to identify problems, gather data, establish facts, draw valid conclusions and develop suitable recommendations to propose and if necessary, negotiate with the external parties. Proficient with financial analysis/modeling and Microsoft Office 365 including Word, Excel, Outlook and Teams. Strong negotiation and relationship building skills, along with an understanding of contractual documents and the ability to effectively communicate terms to providers. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Salary Range: $63,000 - $125,125 Salary Range Disclaimer: The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Department: Fee For Services Contracting Equal Employment Opportunity: CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Where To Apply: Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand: Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. Physical Demands: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US: Must be eligible to work in the U.S. without Sponsorship. Requisition Number: 21255
This role will lead, guide, strategize and manage negotiations for provider-specific institutional, ancillary, and professional contracts. Key responsibilities include negotiating contract terms in accordance with regulatory requirements, analyzing financial data to evaluate implications across various business lines, while ensuring compliance with company policies and procedures, and coordinating with the Payment Transformation team to transition fee-for-service arrangements to value-based care. This role will also oversee complex projects related to provider contracts, reimbursement methods, documentation and amendments, and participate in internal workgroups and committees, ensuring compliance and advising on business strategies. We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. Essential Functions
Contract Development and Negotiation Research and Data Analysis Recruitment and Relationship Regulatory and Healthcare Landscape Administration Qualifications
Education Level: Bachelor's Degree in Business Administration, Healthcare, Public Health, Finance or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Experience: 2 years healthcare, business or related field. 1 year experience in contracting, provider recruitment or provider relations. Preferred Qualifications: Masters degree in Business or Healthcare Administration. Knowledge of healthcare or health insurance payor industry (Medicare, Medicaid, Commercial, DSNP and other payor programs), including legal and regulatory requirements. Solid understanding of CPT-4, HCPCS, revenue and ICD coding, medical terminology, claims payment, contract negotiations and problem resolution. Knowledge, Skills and Abilities (KSAs): Understanding of multiple reimbursement methodologies used in healthcare provider contracting, including third party payment methodologies, delegated arrangements and payor networks (PPO, HMO, value-based contracting, etc.). Effective time and project management skills to be able to plan and monitor activities to ensure achievement of organizational goals. Strong interpersonal skills to effectively interface with all levels of staff, providers, vendors, and business-related associates. Ability to lead project teams towards goal attainment and work independently or as part of a team. Strong analytical, problem-solving and critical thinking skills, with the ability to use reason to identify problems, gather data, establish facts, draw valid conclusions and develop suitable recommendations to propose and if necessary, negotiate with the external parties. Proficient with financial analysis/modeling and Microsoft Office 365 including Word, Excel, Outlook and Teams. Strong negotiation and relationship building skills, along with an understanding of contractual documents and the ability to effectively communicate terms to providers. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Salary Range: $63,000 - $125,125 Salary Range Disclaimer: The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Department: Fee For Services Contracting Equal Employment Opportunity: CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Where To Apply: Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand: Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. Physical Demands: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US: Must be eligible to work in the U.S. without Sponsorship. Requisition Number: 21255