Network Contract Specialist-Sr.

Independent Health; United States; Hybrid; USD 65,000 - 75,000; Full time

Benefits offered by this job

Generous paid time off

Full benefits

Job summary

Independent Health in Williamsville, NY, is seeking a Network Contract Specialist-Senior for a hybrid role with onsite attendance. The position requires development and maintenance of provider contracts, coordination with credentialing and legal teams, and support for negotiations.

Compensation ranges from $65,000 to $75,000 annually, with a full benefits package and generous PTO. This role interacts with multiple departments to ensure compliance with state and federal regulations and to build

Qualifications

• Must have 3+ years of experience in legal and/or contracting field.
• Excellent analytical and critical thinking skills for decision making and process implementation.
• Strong written and oral communication abilities across levels.
• Ability to interpret and implement all aspects of provider contracts.
• Experience coordinating with credentialing and legal departments.

Responsibilities

• Develop and maintain provider contract agreements and amendments.
• Coordinate contract management to ensure current, compliant documents.
• Support contract negotiations and research provider issues.
• Collaborate with Credentialing, Legal, Reimbursement, and other teams.
• Represent Network Contract Management on cross-functional teams.

Skills

Analytical thinking

Critical thinking

Oral and written communication

Organizational skills

Project management

Provider contract understanding

Stakeholder communication

Interpersonal skills

Multitasking under pressure

Company values alignment

Education

High school diploma or GED

Bachelor’s degree preferred

Job description

Overview

The Network Contract Specialist-Senior shall be responsible for various aspects of hospital, physician, facility, laboratory, dialysis, and ancillary (herein collectively referred to as “Network Provider”) contract development and maintenance. This will include preparation and implementation of all Network Provider agreements and amendments and coordinating with credentialing and legal departments for network participation and contract completion. The Network Contract Specialist- Senior will be required to work with the Manager-Network Contract Management and members of the Legal Department to ensure that all contracts are compliant with all state and federal regulations. The individual will assist with the negotiation/renegotiations of contracts as needed. They will be required to maintain cooperative business relationships with providers and their counterparts in the provider community. The Network Contract Specialist-Senior will be accountable for researching and accomplishing Network Provider problem resolutions as required by NCM management and other internal departments. The Network Contract Specialist-Senior may be required to represent NCM on operational teams for certain administrative tasks.

Qualifications

• High school diploma or GED required.
• Bachelor’s degree preferred.
• Three (3) years of experience in legal and/or contracting field required.
• Strong analytical and critical thinking skills that enable the individual to demonstrate decision making, process implementation, and recommendations to support organizational and team initiatives.
• Proficiency in recognizing how decisions and processes implemented and designed within the business unit impact and interrelate with other internal business units and external stakeholders.
• Excellent oral and written communication skills.
• Strong organizational skills and ability to prioritize, multitask, and work in a fast-paced environment.
• Project management skills with the ability to complete projects and assignments with minimal supervision.
• Ability to understand, interpret and implement all aspects of provider contracts.
• Ability to concisely and logically present complex issues verbally and in writing, to interact effectively at all levels and to listen carefully.
• Strong interpersonal skills.
• Effectively handle diverse assignments under shifting priorities and under tight time frames.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Essential Accountabilities

Responsible for the development of provider contract agreements and legal documents. Must manage and secure that each agreement has proper language, appropriate lines of business, and integration of correct fee schedules (e.g. business and regulatory). Monitor and maintain provider files and coordinate contract management to ensure executed contracts or amendments are current, compliant, and completed within set timeframe goals. Identify and analyze information needed to support contract negotiations. Prepare appropriate concise information for inclusion in contracts, amendments, letter of agreements or other binding documents. Represent Network Contract Management department with compliance requirements to develop regulatory adherence processes and initiatives (for example, corporate initiatives, and compliance meetings). Interpret and compile audit information requests from CMS, DOH, and internal department and develop comprehensive responses. Peer review for assigned Network Provider (or other) documentation, to seek and ensure all outstanding information is received from team analyst and reimbursement teams. Responsible for receiving provider requests and ensure the timely processing of requests including provider outreach and internal department inquiries; respond to provider inquiries for contracts, fee schedules or other. Develop Network Provider network through identification of network need, provider outreach, secure positive relationships, and collaboration with Network Providers. Contract implementation including coordinating analytics, lead operational tasks and deliver provider servicing. Ensure that all provider contracts related resource payments and incentives are timely and accurate and that all paperwork is correctly submitted to accounts payable and is received by providers according to the contract provisions. Collaborate with Family Choice of WNY on strategies for the implementation and program development in skilled nursing facilities as requested by NCM leadership. This will include initiating contractual arrangements, fee schedule implementation, network maintenance, and fostering relationships with Family Choice facilities. Accountable for creating department reference tools, such as tip sheets, standard operating procedures, etc. to support efficiencies in specific team tasks. Collaborate and provide support and communication with Credentialing, Legal, Provider Network Administration, Reimbursement, Utilization Management, Finance, Claims, Servicing, and other teams to ensure appropriate tasks are completed for new or existing provider implementations or initiatives. Communicate effectively with both internal and external representatives. Participate on cross-functional teams as requested. Support the strategic goals of Manager, Director, and Senior Leadership in meeting corporate and strategic goals.

This is a hybrid position with onsite attendance required at our Williamsville location.

Hiring Compensation Range: $65,000 - $75,000 annually Compensation may vary based on factors including but not limited to skills, education, location and experience. In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Aff … Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.

Current Associates must apply internally via the Job Hub.

The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation.

Our culture sets us apart. Our core values drive who we are and the work we do. As a member of our family, you’re part of something special, in your work and in the community. We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed. We are here to continue learning and to generate important dialog. We are committed to doing what matters most - reaching out, working together, and caring for our community. A healthy community benefits everyone who lives in it. You too can be part of making difference in the lives of others, together we achieve so much more.

Please click here to view our Community Reports.

We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Human Resources at: [e-mail] or Human Resources, 511 Farber Lakes Drive, Williamsville, NY 14221.

Please note, we do not accept unsolicited resumes. We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.