Provider Contracting Specialist

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

Job summary

USFHP is seeking a Provider Contracting Specialist in Manhattan, NY, offering hybrid work and an exempt full-time role. The person negotiates, implements, and manages the full contract lifecycle with providers, ensuring TRICARE and URAC compliance, and builds strong provider relationships.

The role involves analyzing business needs, reviewing rate schedules, and collaborating with utilization management, marketing, and credentialing to support network development and contract performance.

Qualifications

• Bachelor's degree required.
• 3–5 years in provider contracting.
• Experience with hospital or large network contracting is a plus.
• Familiar with DRG, fee-for-service, bundle payments models.
• Proficiency in Microsoft Office (Word, Excel, PowerPoint, Access).

Responsibilities

• Review, analyze, negotiate, implement, and maintain contracts with understanding of rate schedules and language.
• Identify network development opportunities through financial analysis and product development.
• Define performance improvement opportunities.
• Assist with applications for completeness and timeliness per guidelines.
• Assist with provider orientation and training.
• Facilitate interdepartmental collaboration on contracting issues.
• Provide guidance on Plan policies, provider manual, and directory.
• Research and respond to provider inquiries including credentialing, terms, and reimbursement.
• Document inquiries and resolutions.
• Monitor contract performance through claims/data analysis.
• All other duties as assigned by management.

Skills

Negotiation

Analytical

Communication

Organization

MS Office

Deadline-driven

SalesForce

Conduent

Education

BA/BS

Tools

SalesForce

Conduent

Job description

Title: Provider Contracting Specialist

Department: Contracting Department

Reports To: Manager, Contracting & Business Analytics

Location: Manhattan, NY - HYBRID

Education: Bachelor's Degree Required

Job Type: Full Time, Exempt

Job Summary

Provider Contracting Specialist is a specialized healthcare professional who negotiates, implements, and manages the full contract lifecycle between healthcare providers and the Plan. This role ensures all agreements meet TRICARE regulations and URAC standards. Ensures providers understand Plan policies and contractual requirements. Develop and maintain positive working relationships with participating providers. Conduct analysis of business need and maintain a comprehensive network; collaborates with utilization management, marketing, member services and credentialing.

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 opportunitie
• 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
• Provides general instruction and support on USFHP products, provider manual, provider directory, Plan policies and procedures
• Research, resolve, and respond to provider/ancillary provider inquiries including, but not limited to, 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 claims and data analysis
• All other duties as assigned by management

Years of Experience

• 3-5 years' experience in a provider contracting role; experience with hospital or large network contracting a plus
• 2- 3 years' experience working with mental and physical medicine providers including medical groups, health systems, ancillary providers, and allied health professionals.
• Familiar with various reimbursement models including DRG, fee for service, bundle payments, etc.
• Proficiency in Microsoft Office: Word, Excel, PowerPoint, and Access
• Must be organized and detail oriented.
• Ability to meet stringent deadlines and adjust priorities with business needs
• Excellent communication & analytical skills.
• Experience with SalesForce & Conduent a plus

Education/Licensure/Certification

• BA/BS required

SALARY RANGE: $85,000.00 to $90,000.00

SVCMC IS AN EQUAL OPPORTUNITY EMPLOYER - ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO PROTECTED VETERAN STATUS, DISABILITY, OR OTHER CHARACTERISTICS PROTECTED BY LAW.