Healthcare Network & Contracts Specialist

RiseMe; Boston (MA); On-site; USD 70,000 - 110,000; Full time

Benefits offered by this job

Fantastic medical, dental, and vision

HSA contributions

Life Insurance

Disability insurance

Flexible Spending Accounts

401(k) match

Paid holidays

Summer Fridays

Vacation & sick time

Tuition reimbursement

Health and wellness reimbursement

Company events

Job summary

Cobalt Benefits Group is seeking a Healthcare Provider Network & Contract Management Specialist in Boston to maintain provider data, contracts, and pricing configurations within the health plan administration system.

The role collaborates across teams and clients to ensure accurate implementation and ongoing maintenance of provider networks, reimbursement methodologies, and contract testing before production updates.

Qualifications

• Associate degree or equivalent combination of education and experience.
• Three or more years of related experience preferred.
• Working knowledge of Microsoft Office applications, including Outlook, Excel, and Word.
• Experience with provider contracts, provider network maintenance, reimbursement validation, contract configuration, or healthcare network tiering preferred.
• Experience working with 835 and 837 electronic claim files preferred.
• Strong customer service skills with a commitment to supporting internal and external stakeholders.
• Excellent organizational, analytical, and problem-solving skills.
• Ability to prioritize work, manage multiple assignments, and work independently in a fast-paced environment.
• Strong written and verbal communication skills.

Responsibilities

• Implement, configure, and maintain client-specific provider contracts, reimbursement methodologies, pricing arrangements, and related system records.
• Validate contract configuration against approved client requirements, source documentation, fee schedules, and reimbursement methodologies.
• Develop, document, and execute contract testing scenarios to ensure accurate pricing, reimbursement, and claims processing outcomes prior to implementation or production updates.
• Coordinate contract implementation and maintenance activities with internal departments, network partners, clients, and other stakeholders.
• Maintain organized and accurate documentation related to provider networks, contracts, pricing arrangements, affiliations, tiering structures, and implementation decisions.
• Support provider network tiering setup, validation, testing, and ongoing maintenance activities.
• Monitor medical and dental network changes to ensure updates are implemented accurately, consistently, and in a timely manner.
• Perform provider contract and pricing maintenance, including the identification and resolution of configuration discrepancies.
• Import and analyze 835 and 837 electronic claim files to support contract validation, reimbursement analysis, and provider maintenance activities.
• Respond to provider, network, and contract-related requests within established service standards.
• Support audits, quality reviews, issue resolution, and continuous improvement initiatives related to provider data, contract configuration, network maintenance, and reimbursement accuracy.

Skills

Microsoft Office

Provider contracts

Provider network maintenance

Reimbursement validation

835/837 electronic claims

Customer service

Analytical skills

Communication skills

Education

Associate degree or equivalent

Tools

Excel

Outlook

Job description

Cobalt Benefits Group is seeking a Healthcare Provider Network & Contract Management Specialist in Boston to maintain provider data, contracts, and pricing configurations within the health plan administration system.

The role collaborates across teams and clients to ensure accurate implementation and ongoing maintenance of provider networks, reimbursement methodologies, and contract testing before production updates.