Hybrid Provider Contracting & Network Specialist

SVCMC Inc; New York (NY); Hybrid; USD 85,000 - 90,000; Full time

Benefits offered by this job

Hybrid work schedule

Medical coverage

Vision coverage

Dental benefits

401(k) retirement plan

Job summary

SVCMC, Inc. is seeking a Provider Relations Contracting and Network Specialist in New York, NY to lead contract negotiations and manage provider networks. The role requires experience with provider contracts, hospital and ancillary vendors, and risk-based contracting concepts.

The position is full-time with a hybrid schedule and a competitive benefits package including medical, vision, dental, and a 401(k) plan with employer match. Strong communication and analytical skills are essential.

Qualifications

• BA/BS required.
• min. of 2 years’ experience in a provider contracting role with existing marketing relationships; experience with value based contracting a plus.
• 3-5 years’ experience working with providers including medical groups, ancillary vendors, and allied health professionals.

Responsibilities

• Review, analyze, negotiate, implement, and maintain existing contracts with an understanding of professional rate schedules and contractual language.
• Identify network development opportunities through financial analysis, client requests, and product development.
• Define performance improvement opportunities.
• Assist with initial applications for completeness, timeliness, and accuracy in accordance with established guidelines.
• Assist with provider orientation and training.
• Facilitate interdepartmental collaboration to resolve complex provider issues related to contracting and contract configuration.
• Manages territory, inclusive of strategic network partnerships and the Plan's family health centers.
• Provides general instruction and support on USFHP products, provider manual, provider directory, Plan policies and Plan procedures.
• Research, resolve, and respond to provider/ancillary provider inquiries including participation requirements, credentialing requirements, credentialing status, contract terms, fee schedules, reimbursement, utilization, access/availability standards, member eligibility, consult report requirements, etc.
• Document and track inquiries received and resolution.
• Monitor contract performance through site visits, claims and data analysis.
• Monitor quality and regulatory compliance and participate in annual HEDIS activities.
• Assist with Provider Panel Report Cards and Scorecard
• All other duties as assigned by management

Skills

Excellent communication

Analytical skills

Salesforce experience

Microsoft Office

Education

BA/BS

Tools

Salesforce

Microsoft Office

Job description

SVCMC, Inc. is seeking a Provider Relations Contracting and Network Specialist in New York, NY to lead contract negotiations and manage provider networks. The role requires experience with provider contracts, hospital and ancillary vendors, and risk-based contracting concepts.

The position is full-time with a hybrid schedule and a competitive benefits package including medical, vision, dental, and a 401(k) plan with employer match. Strong communication and analytical skills are essential.