Blue Cross of Idaho is looking for a Provider Contract Specialist to be a part of the Provider Contracting team! This role will be responsible for the implementation of standardized contracts and reimbursement rates. You will monitor the adequacy and performance of multi-specialty provider networks and ensure Blue Cross of Idaho networks meet the needs of its membership and operates in compliance with regulatory requirements. This person will need to maintain a positive, collaborative, and effective relationship between Blue Cross of Idaho and the various health care provider communities.
We are looking for a Provider Contract Specialist with:
What a day would look like:
- Experience: 2 years' provider relations, contracting, or related experience
- Education: Bachelor's Degree or equivalent work experience (Two years' relevant work experience is equivalent to one-year college)
- Monitor adequacy and financial performance of all assigned contracts.
- Identify provider payment or utilization variations and ensure follow-up action.
- Maintain active communication with assigned providers and communicates issues or questions raised by provider office with key stakeholders. Responds to provider request for information regarding company contracting programs and policies.
- Develop and implements reimbursement strategies designed to control healthcare costs by reimbursing providers appropriately.
- Implement standardized contracts with providers. Participates in the negotiation of contracts for new and existing provider networks.
- Prepare contract development and template standardization and ensure they meet legal and regulatory requirements.
- Ensure accurate implementation and administration of assigned contracts, amendments, and projects.
- Organize, prepare, and deliver presentations to provider groups and/or office staff.
- Maintain documentation related to processes and procedure, training materials, program descriptions, and technical program requirements.
- Performs other duties and responsibilities as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
This job has expired.