Provider Contracts Specialist - Health Plan

Sanford Research; Iowa (LA); Hybrid; USD 60,000 - 80,000; Full time

Job summary

An established industry player seeks a Provider Contract Specialist to coordinate pricing arrangements and maintain compliant networks. This role involves negotiating contracts, analyzing data for reimbursement proposals, and collaborating with various departments. The ideal candidate will have a strong background in healthcare insurance, excellent communication skills, and the ability to work both independently and as part of a team. Join a dynamic organization that values work-life balance and offers a comprehensive benefits package, including health and retirement plans.

Benefits

Health insurance

Dental insurance

Vision insurance

401(k) plan

Generous paid time off

Qualifications

• Bachelor's degree or equivalent experience preferred.
• Experience with healthcare insurance or network management is a plus.

Responsibilities

• Maintain and coordinate pricing arrangements with provider groups.
• Analyze data to develop reimbursement proposals for the Health Plan.

Skills

Contract negotiation

Data analysis

Communication skills

Healthcare insurance knowledge

MS Office proficiency

Education

Bachelor’s degree in finance, business, healthcare administration, or communications

Job description

For more information about Total Rewards, visit https://sanfordcareers.com/benefits

Sanford Health

Sanford Health Provider Contracts Specialist - Health Plan Remote, Iowa

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Job Details

Facility: Remote IA

Location: Remote, IA

Shift: Varies

Job Schedule: Full time

Weekly Hours: 40.00

Salary Range: $24.00 - $38.50

Department Details: While this position is primarily remote, some in-person attendance will be required for trainings, team meetings, or special projects. These on-site responsibilities will be scheduled in advance.

Job Summary

The Provider Contract Specialist (PCS) is responsible for maintaining, coordinating, and establishing pricing arrangements involving provider groups, facilities, and ancillary entities joining the Health Plan networks. This includes creating standard contracts for providers across the Health Plan service area. The PCS plays a key role in building and maintaining compliant networks, which may involve provider recruitment activities. They work with the chain of command to develop and implement contracting strategies, evaluate and negotiate contracts, and prepare agreements. The role requires analyzing data to develop reimbursement proposals that benefit members and the Health Plan, and collaborating with team analysts and other departments to ensure accurate system updates and reimbursements. The PCS must understand the end-to-end provider engagement processes and may assist in network education, onboarding, and relationship building.

Qualifications

• Bachelor’s degree or equivalent experience in finance, business, healthcare administration, or communications (preferred but flexible with strong work experience)
• Experience with healthcare insurance or network management, including reimbursement methodologies (behavioral health experience a plus)
• Strong skills in analyzing, understanding, negotiating, and communicating contract terms and reimbursement rates
• Proficiency in MS Office applications
• Willingness to travel occasionally, including overnight stays
• Must have a designated workspace with high-speed internet for remote work

Benefits

Sanford Health offers an attractive benefits package including health, dental, vision insurance, life insurance, 401(k) plan, work/life balance benefits, and generous paid time off. For more information, visit Total Rewards.

Sanford is an EEO/AA Employer and provides accommodations for individuals with disabilities upon request. Employment is contingent upon passing a drug screen and background check.

Req Number: R-0220493

Job Function: Legal and Compliance