CareFirst BlueCross BlueShield
Provider Contracting Specialist (Remote)
CareFirst BlueCross BlueShield, Baltimore, Maryland, United States, 21276
Overview
Provider Contracting Specialist (Remote) – CareFirst BlueCross BlueShield. This role will lead, guide, strategize and manage negotiations for provider-specific institutional, ancillary, and professional contracts, and coordinate with related teams to transition fee-for-service arrangements to value-based care. Responsibilities
Contract Development and Negotiation: act as SME in contracting and reimbursement, support contract development and negotiations with providers, and draft fixed-price and cost reimbursement agreements using claims and market data. Research and Data Analysis: collect, analyze, and interpret data from internal and external sources to inform network contracts and summarize findings. Recruitment and Relationship: develop and maintain relationships with contracted providers across specialties; collaborate with internal teams to address network adequacy and recruitment needs. Regulatory and Healthcare Landscape: monitor regulatory trends and ensure contracts comply with state and federal requirements; participate in workgroups or legislative activities as needed. Administration: coordinate tasks across departments, validate final agreements and amendments, and ensure accurate and timely payments for services. Qualifications
Education : Bachelor’s Degree in Business Administration, Healthcare, Public Health, Finance or related field, or equivalent combination of education and work experience. Experience : 2 years in healthcare, business or related field; 1 year in contracting, provider recruitment or provider relations. Preferred Qualifications : Master’s degree in Business or Healthcare Administration; knowledge of healthcare payor industry (Medicare/Medicaid/Commercial, DSNP, etc.); familiarity with CPT-4, HCPCS, ICD coding, claims payment, and contract negotiations. Knowledge, Skills and Abilities : understanding of multiple reimbursement methodologies, strong time and project management, excellent interpersonal and negotiation skills, analytical and problem-solving abilities, proficiency with Microsoft Office 365, and ability to manage multiple demands and deadlines. Additional Details
Location : Remote within the CareFirst service area (Baltimore/Washington metro); periodic in-person meetings, training, or activities may be required. Salary Range : $63,000 – $125,125 Department : Fee For Services Contracting Equal Employment Opportunity : CareFirst BlueCross BlueShield is an Equal Opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran status, disability status, or genetic information. How to Apply : Please visit our website to apply: www.carefirst.com/careers Note: This description reflects the responsibilities and qualifications for the Provider Contracting Specialist (Remote) role as posted. It does not imply a specific timeline for hiring or job availability.
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Provider Contracting Specialist (Remote) – CareFirst BlueCross BlueShield. This role will lead, guide, strategize and manage negotiations for provider-specific institutional, ancillary, and professional contracts, and coordinate with related teams to transition fee-for-service arrangements to value-based care. Responsibilities
Contract Development and Negotiation: act as SME in contracting and reimbursement, support contract development and negotiations with providers, and draft fixed-price and cost reimbursement agreements using claims and market data. Research and Data Analysis: collect, analyze, and interpret data from internal and external sources to inform network contracts and summarize findings. Recruitment and Relationship: develop and maintain relationships with contracted providers across specialties; collaborate with internal teams to address network adequacy and recruitment needs. Regulatory and Healthcare Landscape: monitor regulatory trends and ensure contracts comply with state and federal requirements; participate in workgroups or legislative activities as needed. Administration: coordinate tasks across departments, validate final agreements and amendments, and ensure accurate and timely payments for services. Qualifications
Education : Bachelor’s Degree in Business Administration, Healthcare, Public Health, Finance or related field, or equivalent combination of education and work experience. Experience : 2 years in healthcare, business or related field; 1 year in contracting, provider recruitment or provider relations. Preferred Qualifications : Master’s degree in Business or Healthcare Administration; knowledge of healthcare payor industry (Medicare/Medicaid/Commercial, DSNP, etc.); familiarity with CPT-4, HCPCS, ICD coding, claims payment, and contract negotiations. Knowledge, Skills and Abilities : understanding of multiple reimbursement methodologies, strong time and project management, excellent interpersonal and negotiation skills, analytical and problem-solving abilities, proficiency with Microsoft Office 365, and ability to manage multiple demands and deadlines. Additional Details
Location : Remote within the CareFirst service area (Baltimore/Washington metro); periodic in-person meetings, training, or activities may be required. Salary Range : $63,000 – $125,125 Department : Fee For Services Contracting Equal Employment Opportunity : CareFirst BlueCross BlueShield is an Equal Opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran status, disability status, or genetic information. How to Apply : Please visit our website to apply: www.carefirst.com/careers Note: This description reflects the responsibilities and qualifications for the Provider Contracting Specialist (Remote) role as posted. It does not imply a specific timeline for hiring or job availability.
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