Healthcare Provider Contract & Network Specialist

RiseMe; Providence (RI); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Fantastic medical, dental, and vision

HSA employer contributions

Basic Life and AD&D

Disability insurance

Flexible Spending Accounts

401(k) with employer match

Paid holidays

Summer Fridays

Vacation and sick time

Tuition reimbursement

Health and wellness reimbursement

Company events

Job summary

Cobalt Benefits Group is seeking a Healthcare Provider Network & Contract Management Specialist to maintain provider network data and contract configurations within our health plan administration system. You will implement client contracts, validate configurations, and support testing to ensure accurate pricing and reimbursement outcomes.

You will collaborate with internal teams, clients, and external partners to keep provider data current, perform contract maintenance, and assist with audits

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

MS Office

Customer service

Analytical thinking

Communication skills

Education

Associate degree

Tools

Outlook

Excel

Word

Job description

Cobalt Benefits Group is seeking a Healthcare Provider Network & Contract Management Specialist to maintain provider network data and contract configurations within our health plan administration system. You will implement client contracts, validate configurations, and support testing to ensure accurate pricing and reimbursement outcomes.

You will collaborate with internal teams, clients, and external partners to keep provider data current, perform contract maintenance, and assist with audits