Network Contracting & Analysis Specialist

Excellus BCBS; City of Rochester (NY); Hybrid; USD 62,000 - 107,000; Full time

Benefits offered by this job

Remote work option

Job summary

Excellus BCBS is seeking a seasoned professional to influence and manage provider network contracting and administration. The role focuses on developing networks, evaluating provider reimbursement, and negotiating contracts aligned with corporate strategy.

You will analyze provider data, engage with clinical and operational leadership, and ensure compliance with regulatory mandates while supporting privacy and ethical standards.

Qualifications

• Six years of provider network reimbursement or related experience.
• Two years of provider contracting or reimbursement analysis.
• Demonstrated experience with provider reimbursement methodologies.
• Ability to draft, interpret and apply contractual language.
• Technical skills including modeling and financial analysis.
• Understanding of medical care delivery, industry trends, and regional market dynamics.

Responsibilities

• Establishs and maintains network adequacy for assigned provider types, regions and/or lines of business; acts as SME for provider network contracting and administration.
• Analyzes, develops, and proposes formal provider reimbursement recommendations within budgets and strategy.
• Collects and interprets data to support contracting and administration activities; applies contract terms and regulatory requirements.
• Prepares and presents information, findings, and recommendations to stakeholders.
• Liaises with stakeholders to coordinate contract/administration work items and tracks progress.

Skills

Provider network reimbursement

Contract negotiation

Financial analysis

Regulatory compliance

Data interpretation

Education

Bachelor's degree in Health Care Administration

Tools

Financial modeling

Job description

Excellus BCBS is seeking a seasoned professional to influence and manage provider network contracting and administration. The role focuses on developing networks, evaluating provider reimbursement, and negotiating contracts aligned with corporate strategy.

You will analyze provider data, engage with clinical and operational leadership, and ensure compliance with regulatory mandates while supporting privacy and ethical standards.