Principal Provider Contract Analyst

Job Description

This position serves as the provider account executive for the Plan's largest and most strategically important healthcare delivery systems and provider organizations. This role serves as the “quarterback” and central point of coordination and integration between key provider partners and Blue Cross NC. In this highly visible role, the incumbent cultivates trusted partnerships with provider executives, leads complex negotiations, is accountable for resolving complex provider issues, and influences strategic initiatives that advance organizational priorities.

The Principal Provider Contract Analyst is responsible for the end-to-end provider contracting lifecycle, including network strategy development, reimbursement innovation, provider engagement, contract negotiation, implementation, performance management, and compliance oversight. As a strategic advisor and subject matter expert, the incumbent leads cross-functional workgroups and initiatives that drive innovative provider strategies, support value-based care initiatives, improve affordability and quality outcomes, and strengthen provider partnerships that enhance Blue Cross NC's competitive position in the marketplace.

What You'll Do

• Manage executive-level relationships with assigned health systems and provider organizations, fostering strategic partnerships that support a collaborative approach to quality care, network development and stability, affordability, and identification and resolution to barriers for success
• Serves as primary point of accountability for complex and escalated provider issues, facilitating timely resolution through collaboration with internal and external stakeholders
• Lead the development, negotiation, implementation, and ongoing management of complex provider contracts and reimbursement arrangements, including:
  • Lead the development, negotiation, implementation, and ongoing management of complex provider contracts and reimbursement arrangements, including:
  • Value based, shared risk arrangements
  • Strategic network and contracting initiatives
  • Cost of Care management strategies
  • Quality and Performance improvement programs
  • Product strategy and competitive positioning
  • Provider Incentive Programs
  • Contract administration and operational enhancements
• Lead cross-functional teams and stakeholders discussions to ensure resources are assigned to address provider issues and concerns, as well as support the advancement of strategic Plan initiatives. Provide direct input on initiatives and serve as the subject-matter expert for assigned providers regarding contract and relationship status, trends, innovation, and emerging opportunity

• Partner closely with the assigned strategic relationship support analyst to coordinate provider engagement activities, ensure provider educational needs are met, and proactively identify, resolve and track organizational issues
• In collaboration with the strategic relationship support analyst, jointly lead provider meetings and executive touchpoints, including agenda development, facilitation, capture action items, meeting documentation and follow-up accountability
• Develop business cases, financial analyses, feasibility assessments, and forecasting models to evaluate contract opportunities, reimbursement strategies, and innovative provider arrangements
• Monitor provider performance and support initiatives that improve quality, affordability, member experience, and value-based care outcomes.

Limited travel is required within the state of NC. Candidates for this role must live in NC. Onsite expectations will be discussed during the interview process.

What You Need

• Bachelor's degree or advanced degree (where required)
• 8+ years of experience in related field.
• In lieu of degree, 10+ years of experience in related field.

Bonus Points

• Proven experience in healthcare provider contracting, network management, provider relations, or managed care experience, including accountability for large health systems and strategically significant provider organizations.

• Demonstrated success leading complex provider contract negotiations, including value-based care arrangements, risk-sharing models, alternative payment methodologies, and reimbursement innovation.

• Proven ability to build and maintain executive-level relationships with health system executives, physician leaders, and other senior healthcare stakeholders

• Experience leading cross-functional strategic initiatives involving network strategy, finance, actuarial, clinical, operations, legal, and product teams to achieve organizational objectives

• 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, with the ability to translate insights into actionable business strategies.

What You’ll Get

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community 

• Work-life balance, flexibility, and the autonomy to do great work 

• Medical, dental, and vision coverage along with numerous health and wellness programs 

• Parental leave and support plus adoption and surrogacy assistance 

• Career development programs and tuition reimbursement for continued education 

• 401k match including an annual company contribution 

• Learn more 

Where You’ll Work

Our Hybrid-Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.

In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote-Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid-Flex or Remote-Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$118,691.00 - $189,906.00

Skills

Care Plan Development, Consulting, Contract Administration, Contracting Strategies, Contract Negotiations, Healthcare Networks, Leadership, Medical Centers, Network Development, Operations Administration, People Management, Program Management, Project Management, Provider Relations, Resource Management, Strategy Development, Strategy Implementation

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About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

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Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application, hiring process, or have technical issues that prevent you from completing your application please notify HR at HR.Staffing@bcbsnc.com.

Blue Cross NC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming

Notice to staffing agencies and search firms: Blue Cross NC does not accept unsolicited resumes from agencies or third parties and is not responsible for fees associated with unsolicited resumes.