Provider Contracting Strategist - Hybrid

USFHP

New York (NY)

Ibrido

USD 85.000 - 90.000

Tempo pieno

29 ore fa

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Descrizione del lavoro

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.

Competenze

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).

Mansioni

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.