Network Contracting Specialist (SCA)

Valid8 Financial, Inc.; Austin (TX); Hybrid; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a dynamic professional to manage provider contracting and negotiations. This role requires building and nurturing relationships with physicians and physician groups while ensuring timely execution of agreements. The ideal candidate will have a strong background in health insurance, excellent negotiation skills, and the ability to work collaboratively in a fast-paced environment. If you are passionate about improving healthcare delivery and have a knack for forging partnerships, this position offers a unique opportunity to make a significant impact in the local market.

Qualifications

• 3+ years of experience in provider contracting or health insurance.
• Strong understanding of managed care and provider business models.

Responsibilities

• Manage SCA negotiations with physicians and groups in the assigned area.
• Build relationships to support local market strategy and continuity of care.

Skills

Negotiation Skills

Relationship Management

Problem Solving

Communication Skills

Financial Acumen

Education

Bachelor's Degree

Equivalent Experience

Job description

Job Responsibilities

• Manages single case agreement (SCA) negotiations with physicians and physician groups in assigned area.
• Prioritizes to ensure all related provider and facility SCA’s are executed timely to ensure continuity of care for members.
• Conducting several negotiations simultaneously to meet growth demands.
• Proactively builds relationships that nurture provider partnerships to support the local market strategy.
• Initiates, nurtures and maintains effective channels of communication with matrix partners including but not limited to, Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing.
• Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position.
• Identify and manage initiatives that improve total medical cost and quality.
• Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.
• Assists in resolving elevated provider service complaints. Research problems and negotiate with internal/external partners/customers to resolve complex and/or escalated issues.
• Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
• Performs other duties as assigned.

Position Requirements

• Bachelor’s degree or equivalent experience in related field, plus 3+ years of work experience within provider contracting and/or health insurance.
• Experience with physician and physician group contracting and negotiations.
• Experience in developing and managing key provider relationships, including senior executives.
• Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners.
• Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models.
• Team player with proven ability to develop strong working relationships within a fast-paced organization.
• Strong written and verbal communication skills. Experience with formal presentations.
• Customer centric and interpersonal skills are required.
• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
• Hybrid/Remote with occasional travel (5%).
• Existing relationships with physicians and physician groups in Texas is highly recommended.