Pay Range:
$83,200.00 - $124,800.00
Please email [email protected] if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
At BCBSRI, our greatest resource is our people.
We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.
We recognize that to do your best work, you have to be your best self.
It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.
Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.
Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.
We’re dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.
Why this job matters:
Negotiate and implement complex contracts with hospitals, physician partner groups, and other health care providers and vendors. Focus on achieving the organization’s financial and business objectives via its contractual relationships with hospitals, physician partner groups and other health care providers and vendors. Serve as a departmental technical expert and coaches, mentors, and assists other Contract Administrators. Serve as trusted resource to Hospital, Physician and/or Ancillary management staff.
What you will do:
Analyze financial terms and evaluate contractual language during negotiation of complex provider agreements.
Coordinate the implementation and the administration of new hospital, physician partner group, ancillary and vendor contracts.
Evaluate, negotiate, and recommend necessary changes to existing contracts to ensure mutual success of the company and partners.
Develop and maintain business relationships between the BCBSRI hospitals, physician partners, ancillary providers and vendors to ensure the effective and ongoing exchange of information. Counsel and educate the partners in the use of company data and resources to achieve quality, performance, and financial objectives.
Monitor, analyze, and report on contract compliance. Explain and interpret the contracts to educate hospitals, physician partners, ancillary providers and vendors relative to issues of non-compliance. Initiate changes and recommend solutions to improve ongoing compliance and ensure objectives are met in future contract periods.
Act as a liaison to providers’ staff; ensure understanding of company policies, administrative procedures, and practices. Provide training as required to ensure staff have the resources to meet performance goals and objectives. Develop and implement feedback mechanisms to determine satisfaction levels relative to administrative support, service, communications, and reimbursement. Ensure that Providers’ issues and concerns are addressed by the organization.
Perform special projects as assigned, which may include work on committee or task forces, research, analysis, communications. Interpret, educate, recommend, and communicate results of research.
Mentor and provide expert technical, business and analytical support to inter-department teams.
Lead department projects and initiatives.
Perform other duties as assigned.
What you need to succeed:
Bachelor’s degree in Business, Health Care Administration, or related field, or an equivalent combination of education and experience
Five to seven years in managing and negotiating comprehensive, complex contracts
In-depth understanding of provider delivery models, provider financing as well as health plan operations and financing
Highly proficient in developing, interpreting and utilizing provider financial and quality data
Strong knowledge of provider reimbursement as well as pay for performance models
Solid understanding of provider billing/claims processing practices, coding standards as well as industry standard payment and medical policies
Strategic and critical thinking skills
Strong analytical skills
Strong business acumen and political savvy
Strong negotiation skills
Strong written and verbal communication skills
Strong problem-solving skills
Ability to work effectively with a wide variety of people in individual and group settings
Strong organizing skills, with the ability to prioritize and respond to shifting deadlines
Strong time management skills
Ability to manage diverse and deadline-oriented workflow
The extras:
Master’s degree in Business or Health Care Administrator
Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:
- In-office : onsite 5 days per week
- Hybrid: onsite 2-4 days per week
- Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.
The law requires an employer to post notices describing the Federal laws. Please visit www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.
