Specialist, Provider Contract

Summary
 As a Provider Contract Specialist, you will be responsible for the establishment and maintenance of financial systems for various provider networks. You will solicit / contract with providers and negotiate pricing during initial and contract renewals. You will also interface with various health plans to resolve problems with contracts, reimbursement methodologies, and claims adjudication.
Description
 

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Logistics:

This position is onsite at 4101 Percival Rd. Columbia, SC, 29229. The hours are 8:00 a.m. - 5:00 p.m. Monday - Friday.

What You'll Do:

• Conduct initial / renewal contract negotiations with providers (hospitals, surgery centers, skilled nursing facilities, radiological providers, independent labs, home health agencies, DME suppliers, pharmacies, etc.) to obtain price concessions and establish provider networks that give the company a competitive advantage.
• Interact / work with providers, government agencies, and internal departments to ensure contract compliance.
• Resolve problems with provider contracts, reimbursement methodologies, benefit structures, and administrative / medical policy issues.
• Prepare / interpret data analysis to determine impact of various pricing decisions related to payment rates and methods negotiated with providers.
• Maintain knowledge of department procedures, current / proposed government regulations, and state / federal laws related to provider contracting and health care delivery.
• Provide direction, guidance, and training to staff.
• Assist with project planning, work assignments, and development of work procedures.

To Qualify for This Position, You'll Need:

• Bachelor's Degree required.
• 3 Years Healthcare and / or managed care contracting, with 2 of the 3 in managed care contracting.

What We can Do for You:

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave – the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.
• Incentive Plan.
• Merit Plan.
• Continuing education funds for additional certifications and certification renewal.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications.  This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.