CareFirst BlueCross BlueShield · 3 days ago
Senior Provider Contracting Coordinator (Hybrid)
Baltimore, MD
Full-time
Hybrid
Mid, Senior Level
$56K/yr - $112K/yr
5+ years expCareFirst BlueCross BlueShield is seeking a Senior Provider Contracting Coordinator to manage and negotiate open negotiation notices from non-participating providers as part of the No Surprises Act process. The role involves coordinating the ONN process, supporting provider agreements, and ensuring compliance with regulatory requirements.
Health CareNon ProfitService Industry
No H1B
Responsibilities
Successfully negotiates cost effective ONNS with non-par providers under the NSA IDR process that is consistent with the CareFirst Network strategy. Work closely Network Contracting identifying providers who my be willing to participate with CareFirst. Negotiate competitive and complex contracts in focused regions that will produce savings to clients. Ensures the economic details in the ONN offers meet the need of key stakeholders. Manages the ONN offer process and works with the Regulatory Operations Manager and Network Contracting to develop strategies and methodologies for negotiations of ONN and contracting with the provider. This includes negotiations, credentialing, financial quantification, network impacts, qualification and competitive analyses, implementation and monitoring of all contracts
Track ONN negotiation efforts, including Develop business cases and present findings to Senior Management to support reimbursement and contracting initiatives through statistical analysis, cost/benefit modeling and analysis. Develop and present business cases to support changes in network strategies including rates, payment methodologies and network configuration. Upon approval, develop and implement the network by sending out RFIs, establishing periodic financial targets, provider criteria for participation, contracts and amendments, renegotiate and manage targeted networks or institutions and gain consensus with other internal areas affected by network changes
Provide ongoing network management support to the Regulatory Operations Manager, Networks Management and senior management, on request and as needed. Assists n the activities of contract professionals in review and preparation of contract documents, the facilitation of training and mentoring and leads team on complex and difficult contracting activities including but not limited to being the focal point for all legal and legislative issues with expert working knowledge of all contracting environments
Develop contracts in coordination with the Legal Department for any changes to standard contract templates. Work with Legal to develop and review any proposed language changes discussed with a provider. Ensure compliance with jurisdictional regulatory requirements and quality monitoring organizations (NCQA)
Improves NSA knowledge and other appropriate regulatory investigation job knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies
Qualification
Required
Bachelor's Degree in Business, Healthcare Administration, or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience
5 years contracting negotiation, healthcare, or related experience/industry
Strong interpersonal skills
Ability to work independently, as well as a member of a team
Strong critical reasoning skills in decision-making, planning and organizing
Advanced understanding of contractual documents
Advanced understanding of the healthcare field and various regulatory agencies
Indepth knowledge of the NSA IDR Process
Subject Matter Expert (SME) for assigned networks; proficient in electronic contract management system
Deep understanding of contractual documents and ability to effectively communicate terms to providers
Effective time and project management skills to be able to plan and monitor activities to ensure achievement of organizational goals
Must possess the ability to problem solve and think strategically
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence
Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging
Preferred
Understanding of a rate regulated versus non-rate regulated market
Working knowledge of provider community and market and its underlying financial dynamics
Working Knowledge of Salesforce
Benefits
Comprehensive benefits package
Various incentive programs/plans
401k contribution programs/plans
Company
CareFirst BlueCross BlueShield
CareFirst. It’s not just our name. It’s our promise.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Ja'Ron Bridges
Interim President and Chief Executive Officer
Doba Parushev
Vice President, Healthworx Ventures
Recent News
2025-10-02
BCBSM, Inc., dba Blue Cross and Blue Shield of Minnesota
2025-09-09
2025-08-07
Company data provided by crunchbase