Provider Contracts Specialist - Health Plan

Sanford Health; Iowa (LA); Remote; Full time

Job summary

A leading health system seeks a Provider Contracts Specialist to manage pricing arrangements with providers. This role involves contract negotiation, collaboration with analysts, and maintaining compliance within the Health Plan networks. The position is primarily remote with occasional in-person requirements. Candidates should possess strong analytical and communication skills, along with a relevant degree or equivalent experience.

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

401(k)

Generous Time Off

Qualifications

• Experience with healthcare insurance or network management.
• Ability to analyze, communicate, and negotiate contract terms.
• Proficiency with contract reading and redlining.

Responsibilities

• Maintain and establish pricing arrangements with provider groups.
• Evaluate and negotiate contracts for the Health Plan.
• Collaborate with team analysts to ensure accurate contract implementation.

Skills

Negotiation

Communication

Analytical Skills

Education

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

Tools

MS Office

Job description

Provider Contracts Specialist - Health Plan | Sanford Careers

Sanford Health

Provider Contracts Specialist - Health Plan Remote, Iowa

Apply Now | Current Employees Apply Here

Share this job

• share to Facebook
• share to Twitter
• share to LinkedIn
• share by email

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Facility: Remote IA
Location: Remote, IA
Shift: Varies
Job Schedule: Full time
Weekly Hours: 40.00
Salary Range: $24.00 - $38.50

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 high-value, compliant networks, which may involve provider recruitment activities. The role involves working closely with management to develop and implement contracting strategies across various provider types, evaluating and negotiating contracts, and preparing standard agreements.

The PCS must identify data needed to evaluate and develop network reimbursement proposals, supporting advantageous arrangements for members and the Health Plan. They will collaborate with team analysts and other departments to ensure accurate contract implementation and serve as a liaison for contract and reimbursement interpretation issues.

The role requires a strong understanding of the Health Plan's provider engagement processes, policies, and procedures, and may include participating in network education, onboarding, and relationship building.

Qualifications

• Bachelor’s degree or equivalent experience in finance, business, healthcare administration, or communications preferred (experience may substitute for education).
• Experience with healthcare insurance or network management, including reimbursement methodologies for commercial and/or government payers. Experience with behavioral health reimbursement is a plus.
• Ability to analyze, communicate, and negotiate contract terms and reimbursement rates. Proficiency with contract reading and redlining.
• Proficiency in MS Office applications.
• Willingness to travel occasionally, including overnight stays for meetings or conferences.
• Must have a designated work area free from distractions and a high-speed internet connection for remote work.

Sanford Health offers a comprehensive benefits package, including health, dental, vision insurance, life insurance, 401(k), work/life balance benefits, and generous time off. For more details, visit https://sanfordcareers.com/benefits.

Sanford is an EEO/AA Employer M/F/Disability/Vet. Accommodations for applicants with disabilities are available upon request. Sanford maintains a drug-free workplace; employment is contingent upon passing a drug screen and background check.

Req Number: R-0220493
Job Function: Legal and Compliance