Provider Network Specialist jobs in Norwalk, CA

Provider Network Specialist coordinates and evaluates the contracts of a healthcare provider network. Participates in the negotiation of contracts and prepares reports and analysis of contract details and statistics. Being a Provider Network Specialist distributes contract information, status updates, and other information within the organization. Requires a bachelor's degree. Additionally, Provider Network Specialist typically reports to a manager or head of a unit/department. The Provider Network Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Network Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Provider Contracting Specialist, Experienced
  • Blue Shield of CA
  • Long Beach, CA FULL_TIME
  • Your Role

    The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Experienced will report to the Sr Manager of Provider Contracting. In this role you will support Medical Group/IPA and Hospital/Facility contracting in Northern California for all Blue Shield products. You will be responsible for comprehensive management of Medical Group/IPA and Hospital/Facility provider network contract processes including derivation, implementation, and ongoing support of assigned provider agreements. You will support contracting initiatives to drive department objectives to achieve timely contract negotiations and implementation that support growth and maintain strong market position and positive reputation in the market.

    Your Work

    In this role, you will:

    • Manage day to day contracting operations for Blue Shield of California.
    • Support attainment of department goals under the leadership of the Director of Provider Contracting and/or Provider Contracting Manager and ensure alignment of these goals with the company's strategic priorities
    • Support review and modification of contracting and cost of health care savings strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches
    • Research opportunities within the assigned local market (i.e., network expansion opportunities, utilization or unit cost excesses, etc.) and assess market trends to drive initiatives which enhance company's market position
    • Supports the development, negotiation, implementation, and maintenance of a comprehensive provider network. This includes supporting the development of payment policies, alternative payment methodologies, fee schedules, provider communications, and retention strategies, as well as the management of online directories.
    • Continually review and modify contracting documents and support work that derives cost of health care savings strategies in anticipation of, and in response to, shifts in provider negotiating approaches
    • Supports attainment of department goals under the leadership of the Director and ensures alignment of these goals with Blue Shield's strategic priorities.
    • Supports, review, and modification of contracting and cost of health care savings strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches.
    • Partners with other team members to meet member and provider service requirements, including identification of network gaps, development and oversight of corrective actions and ongoing management of process improvements. Also identifies service issues across departments, develops process improvements, modifications, and enhancements, and maintains ongoing cross-functional communications.
    • Interact with multi-disciplinary teams including Law Department, Medical Management, Model Contracts, Provider Relations, Analytics and Sales to implement new or renewing provider contracts and help manage the total cost of healthcare within the assigned region
    • Acts as a liaison between Network Management and internal departments and/or external partners.
    • Performs job responsibilities independently on moderately complex projects/assignments and seeks guidance on projects/assignments of higher complexity.
    • Other duties as assigned.

    Your Knowledge and Experience

    • Requires a bachelor's degree in business, healthcare policy, public health or related field, or equivalent experience
    • Requires at least 3 years provider contracting / negotiation/ provider relations experience with increasing complexity
    • Effective project management skills and understanding of contracting administration and general healthcare reimbursement methodologies and knowledge of financial impact analysis.
    • Excellent oral/written, communication and presentation skills, including influence abilities for internal and external discussions
    • Effective project management skills and understanding of contract administration and general healthcare reimbursement methodologies and knowledge of healthcare provider networks
    • Excellent analytical and problem-solving skills, including knowledge of financial impact analysis
    • Experienced in Microsoft Office including, Word, Excel, PowerPoint, and Outlook.
    • Flexible team player who can also work independently

    Pay Range:

    The pay range for this role is: $ 71280.00 to $ 99770.00 for California.

    Note:

    Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.


    External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

     

  • Just Posted

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Provider Contracts Specialist
  • Molina Healthcare
  • Long Beach, CA FULL_TIME
  • ***Remote and must live in Utah*** JOB DESCRIPTION Job Summary Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical...
  • 4 Days Ago

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Provider Contracting Specialist, Experienced
  • BSC
  • Long Beach, CA FULL_TIME
  • Your Role The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Experienced will report to the Sr Manager of Provider Contract...
  • 1 Month Ago

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Provider Contracting Specialist, Senior
  • Blue Shield of CA
  • Long Beach, CA FULL_TIME
  • Your Role The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Senior will report to the Director, Provider Contracting. In t...
  • 1 Month Ago

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Tool Room Clerk - 3rd Shift
  • Employee Force Provider
  • Carson, CA FULL_TIME
  • Great opportunity at a growing plastic packaging manufacturer in the city of Carson. Tool Room Clerk ensure mechanic tools are properly cleaned and put away at the end of the shift. Pay rate: $18 - $2...
  • 1 Day Ago

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Machine Maintenance - 3rd shift
  • Employee Force Provider
  • Long Beach, CA FULL_TIME
  • Great opportunity at a plastic packaging manufacturer hiring maintenance mechanics on their Night Shift. Monday - Friday 10PM - 6:30AM / Must be able to train on first shift Must be open to work overt...
  • Just Posted

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0 Provider Network Specialist jobs found in Norwalk, CA area

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Network Engineer
  • The Intersect Group
  • Torrance, CA
  • Position: Network Engineer Salary: 130-145K Location: Torrance, CA MUST HAVE ACTIVE NETWORK CERTIFICATION Description: Y...
  • 3/28/2024 12:00:00 AM

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Network Engineer
  • CDW
  • Beverly Hills, CA
  • Network Engineer Location: Los Angeles, CA (Beverly Hills) Join the CDW / Sirius Team as a Network Engineer in Los Angel...
  • 3/28/2024 12:00:00 AM

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Network Engineer
  • Heritage Provider Network
  • Northridge, CA
  • Job Description Position Summary: The Network Engineer will be a proactive customer-focused advocate and a strategist wi...
  • 3/28/2024 12:00:00 AM

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Network Engineer - Hybrid
  • Perfict Global, Inc.
  • Los Angeles, CA
  • About Us: Perfict Global is a leading IT consulting services provider focused on providing innovative and successful bus...
  • 3/28/2024 12:00:00 AM

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Network Engineer
  • M-Theory Group
  • Los Angeles, CA
  • Level 1 IT Support Technician Join our team of IT professionals and provide technical support to our clients. Job Descri...
  • 3/25/2024 12:00:00 AM

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Network Engineer
  • Diverse Lynx
  • Los Angeles, CA
  • Role: Network Engineer Experience: 8+ years' Work Location: Los Angeles, California Contract Job Description:- •Experien...
  • 3/25/2024 12:00:00 AM

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Network Engineer
  • The Intersect Group
  • Torrance, CA
  • Job Title: Network Engineer Schedule: HYBRID 3 days on-site, 2 days remote: Monday-Friday 8am-5pm Duration: Full-time op...
  • 3/24/2024 12:00:00 AM

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Network Engineer
  • New-Indy Containerboard LLC
  • Ontario, CA
  • Position Title: Network Engineer Role Summary: The Network Engineer is responsible to ensure the stability and integrity...
  • 3/24/2024 12:00:00 AM

Norwalk is a suburban city in Los Angeles County, California, United States. The population is estimated to be 107,096 as of 2014. It is the 58th most densely-populated city in California. Founded in the late 19th century, Norwalk was incorporated as a city in 1957. It is located 17 miles (27 km) southeast of downtown Los Angeles and is part of the Greater Los Angeles area. Norwalk is a member of the Gateway Cities Council of Governments. Norwalk's sister cities are Morelia, Michoacán, and Hermosillo, Sonora, in Mexico. Norwalk is located at 33°54′25″N 118°5′0″W / 33.90694°N 118.08333°W / 3...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$65,644 to $98,169
Norwalk, California area prices
were up 3.2% from a year ago

Provider Network Specialist in Springfield, MO
As the liaison between provider and the health plan, candidates are tasked with ensuring improved revenue generated and patient quality score.
December 16, 2019
Provider Network Specialist in Stamford, CT
Previous experience in a network development, provider recruitment or provider contracting.
December 04, 2019
Provider Network Specialist in Fort Wayne, IN
In this position, employees will be expected to perform benefits analysis and create reports on provider performance to support the needs of the analysis found.
January 18, 2020