Provider Contracts Specialist
Posted 1hrs ago
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Job Description
Provider Contracts Specialist maintaining pricing arrangements for provider groups in Sanford Health. Collaborating with analysts and ensuring compliance in reimbursement processes.
Responsibilities:
- Works directly with chain of command to develop and implement contracting strategy with various types of providers/facilities across the Health Plan service area.
- Evaluates and negotiates physician, ancillary and hospital contracts, including contract language and reimbursement methodologies for fee for service arrangements.
- Prepares standard accurate agreements to formalize such arrangements.
- Ability to identify data needed to evaluate and develop network reimbursement proposals to develop arrangements advantageous to our members and Health Plan.
- Calls upon team analysts for support.
- Works directly with team analysts and other department managers to understand how the negotiated agreement is translated into the company's systems.
- Prepares timely and accurate communications to other departments for loading finalized agreements into production.
- Assists with internal audit of provider records to ensure accurate reimbursement.
- Serve as liaison to other departments on contract and reimbursement interpretation issues and ensures timely turnaround.
- Must have strong knowledge of the Health Plan's end-to-end provider engagement processes, including interdepartmental handoffs as well as plan policies and procedures to ensure the best possible provider experience.
- Manage or participate in project work as assigned.
- May be called upon to assist in network education, onboarding and overall network relationship building.
Requirements:
- Bachelor’s degree or equivalent experience preferred in the areas of finance, business, health care administration, or communications
- Prior experience working with health care insurance or insurance network management
- Previous experience with behavioral health care reimbursement is a plus
- Experienced in analyzing, understanding, communicating, and negotiating financial impact of contract terms, payment structures, and reimbursement rates with providers
- Proficiency with contract reading and redlining.
- Proficiency in MS Office applications
- Ability and willingness for occasional travel, including overnights
Benefits:
- Health insurance
- 401(k)
- Paid time off
- Flexible work arrangements
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