Capital BlueCross
Sr. Health System Contracting Consultant (Finance)
Leads, directs, derives strategic opportunities specific to health system partners and unique markets, and provides a strong relationship role with certain Capital BlueCross assigned health systems and certain complex physician and ancillary providers throughout contract negotiations, maintaining relationship needs over the course of agreements. Assists in the ongoing development, modification, and implementation of Capital BlueCross' provider network strategy as well as leading the implementation of innovative product designs for contracted providers. Responsible for the negotiating reimbursement approaches aligning with strategic goals, contract structures, product design/network configurations and intelligence gathering. Responsible for the negotiation of contract terms that meet business needs and can be systematically administered, meet regulatory limitations and requirements, consider the financial impact to all lines of business, and are closed in a timely manner. Responsible for presenting and gaining the appropriate level of internal approvals for proposed contract terms. Financial analysis oversight including the ability to interpret and manipulate data to demonstrate outcomes of proposed negotiation tactics.
Under the direction of Corporate and Network leadership this position will manage the transformation from the network's fee-for-service driven model to a model that includes value-based programs and products that align with the Triple Aim objectives (improved satisfaction, quality, and cost), to include capitated risk arrangements, special needs plans, and MA-VBID models. Engaged in the performance of provider incentive programs for STARS and risk adjustment to ensure all providers are performing at 4 STARS or higher.
The individual will work collaboratively with a team of internal partners across all business segments. Supports the Director of Provider Contracting and/or Senior Director in the management of complex projects related to hospitals, and extending to all provider types where the complexity is elevated, network development activities, reimbursement methodologies, contract documents, and statutory and broad-sweeping amendment plans. Leads teams to implement various contracting or network oriented strategies, including ongoing oversight, as necessary. This position will represent the provider contracting unit at a variety of internal work groups and/or on-going oversight committees. As a representative the individual will ensure adherence to both Capital's existing contracts and alignment to strategic contract and reimbursement plans, and advise such committees as to business processes or strategies that align with contract terms and conditions, and those that do not.
JOB REQUIREMENTS
Experience:
Leadership:
Knowledge:
Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.