Principal Provider Contract Analyst

🔥 4 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $118.7k - $189.9k / year

⏰ Full Time

🔴 Lead

🧐 Analyst

👻 Ghost score 0%

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Blue Cross NC

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross NC is a health insurance provider that offers a range of health plans and services to individuals and groups. The company focuses on delivering quality healthcare coverage and improving health outcomes for its members through innovative health programs and services. Blue Cross NC is committed to enhancing access to affordable healthcare while supporting the health and wellness of the communities it serves.

📋 Description

• Manage executive-level relationships with assigned health systems and provider organizations • Serve as the primary point of accountability for complex and escalated provider issues • Develop, negotiate, implement, and manage complex provider contracts and reimbursement arrangements • Lead value-based, shared-risk, strategic network, cost-of-care, quality, performance, product strategy, incentive, and contract administration initiatives • Lead cross-functional teams and stakeholder discussions to resolve provider issues and advance strategic Plan initiatives • Serve as subject-matter expert for assigned providers on contract and relationship status, trends, innovation, and opportunities • Coordinate provider engagement activities and educational needs with the strategic relationship support analyst • Jointly lead provider meetings and executive touchpoints, including agenda development, facilitation, documentation, and follow-up • Develop business cases, financial analyses, feasibility assessments, and forecasting models • Monitor provider performance and support quality, affordability, member experience, and value-based care outcomes

🎯 Requirements

• Bachelor's degree or advanced degree (where required), or 10+ years of experience in lieu of degree • 8+ years of experience in a related field • Proven experience in healthcare provider contracting, network management, provider relations, or managed care, including accountability for large health systems and strategically significant provider organizations • Experience leading complex provider contract negotiations, including value-based care arrangements, risk-sharing models, alternative payment methodologies, and reimbursement innovation • Ability to build and maintain executive-level relationships with health system executives, physician leaders, and senior healthcare stakeholders • Experience leading cross-functional strategic initiatives involving network strategy, finance, actuarial, clinical, operations, legal, and product teams • Strong financial and analytical acumen, including provider economics, contract modeling, forecasting, performance analysis, and cost of care management • Knowledge of healthcare reimbursement methodologies, value-based care principles, regulatory requirements, and healthcare market dynamics • Candidates must live in North Carolina • Limited travel within North Carolina is required

🏖️ Benefits

• Medical, dental, and vision coverage • Health and wellness programs • Parental leave and support • Adoption and surrogacy assistance • Career development programs • Tuition reimbursement for continued education • 401k match including an annual company contribution • Paid Time Off (PTO) • Annual Incentive Bonus based on annual corporate goal achievement and individual performance • Remote-Flex work arrangement with a few in-office visits each year • Work-life balance, flexibility, and autonomy

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