Manager, Provider Contract Analysis/ Reporting

To change the future of health care in California, Blue Shield needs people who believe in the possibilities and are willing to work to make them real. Is this you?

Manages and performs financial analyses and analytics related to provider contracts. Supports provider contract negotiations for the products managed by the business unit (including, but not limited to, Medicare HMO and Healthy Families).

Collaborates with Network Management to develop and implement provider-specific negotiation strategies using solid business judgement and strong financial background to ensure company objectives are achieved.

Leads the activities of Financial Analysts engaged in short- and long-range financial planning related to provider contracting and other operational activities. Monitors and manages production of key reporting related to product and provider financial performance.

Ensures the accuracy and timliness of output and deliverables for assigned functional areas.

Responsible for the oversight and approval of provider financial projections/forecasts to maintain/improve financial performance.

Responsible for the development and maintenance of models and databases to report and forecast product and provider financial performance. Manage opportunities to create/automate/improve analytical tools to create efficiencies and improve accuracy.

Establishes department goals and action plans. Monitors and reports on progress in completing projects and accomplishing goals. Resolves complex issues and problems as needed.

Provides developmental and training opportunities for team members; monitors on-going performance; communicates expectations and results on a regular basis; communicates and interprets changes in guidelines, policies, procedures and other related matters.

Coordinates with other departments to ensure effective financial and operational systems interfaces and to resolve problems or issues.

Prepares and submits reports and recommendations for management review. Prepares and submits summaries and reports to external agencies and organizations as required.

Serves as a resource and provides information as requested to internal and external sources on related operations.

Managerial responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Additional requirements include:

Extensive knowledge of and experience in the health care industry, managed care delivery systems, provider services network development, management and adminstration, and strong negotiating skills.

Thorough knowledge of managed care financing, provider payment methodologies and financial implication analysis specific to providers (Hospitals, IPA/Medical Groups, Etc.).

Demonstrated leadership

Exceptional communication skills, presentation skills, and ability to interact with all levels including senior management.

Strong analytical and business decision-making skills

Superior proficiency with MS Excel and Access; SAS/Crystal highly desired.

Demonstrated success in financial and negotiating strategies

Blue Shield of California is an Equal Opportunity Employer.

Bachelor's degree (B. A.) and seven years related experience; or equivalent combination of education and experience.

Comprehensive knowledge of computers and related financial software.

Excellent human relations and verbal/written communication skills.

Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.