Premera Blue Cross · 4 months ago
Provider Network Executive IV
Mountlake Terrace WA
Full-time
Hybrid
Mid, Senior Level
$109K/yr - $185K/yr
6+ years expPremera Blue Cross is dedicated to improving healthcare and fostering a culture of employee growth and innovation. The Senior Provider Network Executive IV is responsible for developing and maintaining relationships with strategic provider accounts, negotiating complex contracts, and ensuring the alignment of provider engagement with Premera's operational and strategic goals.
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Responsibilities
Develop and execute ongoing account management and service strategies to meet corporate strategic / financial objectives
Lead negotiation and implementation of complex, multifaceted provider contracts
Complete negotiations within preplanned targets, meet timelines, ensure the established implementation period and perform implementation audits for accuracy of assigned accounts
Serve as the main point of contact for the provider and coordinate all Premera interactions with assigned provider accounts
Build and maintain positive relationships, generally with the most complex and significant provider/systems. Utilize consultative skills, industry knowledge, and Premera product knowledge to foster a collaborative approach to quality care, network stability and cost containment
Develop and maintain effective multifaceted and strategic provider networks, with complex payment methodologies and alternate funding arrangements. Participate in payment and delivery systems innovation initiatives
Monitor and analyze financial and quality metrics to assess effectiveness of networks, reports findings to leadership, and creates action plan
Develop strong understanding of providers’ business drivers and performance
Collaborate with Healthcare Economics in rate development and proposal analysis
Lead a high-level, cross-functional team to provide operationally excellent service and support to strategic accounts
Consult and educate assigned account and internal leadership, providing industry and cross-market expertise. Create provider specific and public presentations
Provide input and/or drive development of payment methodologies and provider engagement strategies
Advise Provider Strategy & Solutions (PS&S) leadership and internal stakeholders on account status to facilitate proper internal support of account management efforts to ensure that the resulting final contract supports Premera's operational and strategic goals
Engage providers to promote the concept and understanding of patient engagement adherence, cost savings programs
Other duties and projects as assigned
Qualification
Required
Bachelor's degree or four (4) years of experience in a provider or payer environment
Six (6) years of experience in payer or provider contracting and managing provider relationships in the health care or insurance industry to include four (4) years of experience negotiating contracts
Strong acumen around contract language negotiations
Analytical skills
Working knowledge of the Health Insurance Portability and Accountability Act (HIPAA), the National Committee for Quality Assurance (NCQA), government health care programs, and risk coding
Demonstrated ability to effectively negotiate complex and multi-faceted contracts
Working knowledge of complex and alternate funding arrangements and payment methodologies, i.e., gain sharing, risk strategies
Demonstrated successful verbal and written communication skills including ability to develop and deliver executive and public presentations, training, and meeting facilitation
Knowledge of network development and provider/vendor network recruitment
Knowledge of provider community and market anomalies
Demonstrated ability to develop and execute strategy
Independent work style, self-motivated with ability to lead with minimal direction
Strong analytical skills and problem-solving skills
Results driven with measurable outcomes
Proven ability to lead and direct teams addressing complex issues
Strong interpersonal skills coupled with the ability to foster positive working relationships
Strong organizational, planning and administrative skills
Ability to work under pressure with tight timelines, limited resources, competing priorities and manage project timelines
Preferred
Master's degree in a related field
Benefits
Medical, vision, and dental coverage with low employee premiums.
Voluntary benefit offerings, including pet insurance for paw parents.
Life and disability insurance.
Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
Generous paid time off to reenergize.
Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
Employee recognition program to celebrate anniversaries, team accomplishments, and more.
Commuter perks make your trip to work less impactful on the environment and your wallet.
Free convenient on-site parking.
Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.
Company
Premera Blue Cross
Premera is a leading health plan in the Pacific Northwest, providing comprehensive health benefits and tailored services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Jeffrey Roe
President and Chief Executive Officer
Talha Ashraf
EVP and CFO
Recent News
2025-12-04
TechTarget
2025-10-31
Company data provided by crunchbase