Provider Contracts Specialist - Health Plan

Sanford Health; North Dakota; Remote; Full time

Job summary

A leading health system is seeking a Provider Contracts Specialist to manage contracts with providers and facilities. This role involves negotiating terms, ensuring compliance, and collaborating with various departments to enhance provider engagement. The position is primarily remote but requires occasional in-person attendance for meetings and trainings.

Benefits

Health insurance

Dental insurance

Vision insurance

Life insurance

401(k) retirement plan

Generous time off package

Qualifications

• Experience in health care insurance or network management preferred.
• Strong work experience may waive educational requirements.

Responsibilities

• Maintain and coordinate pricing arrangements with provider groups.
• Evaluate and negotiate contracts for fee-for-service arrangements.
• Assist with internal audits of provider records.

Skills

Negotiation

Communication

Analysis

Education

Bachelor’s degree in finance, business, health care administration or communications

Tools

MS Office

Job description

Provider Contracts Specialist - Health Plan | Sanford Careers

Sanford Health

Provider Contracts Specialist - Health Plan Remote , North Dakota Apply Now Current Employees Apply Here

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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 ND (Central Time)
Location: Remote, ND
Address:
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

Provider Contract Specialist (PCS) is responsible for maintaining, coordinating the process of, and establishing pricing arrangements involving provider groups, facilities and ancillary entities joining the Health Plan networks, including creating standard contracts for providers across the Health Plan service area. The PCS has an integral role in building and maintaining high value and compliant networks which may involve provider recruitment activities. Works directly with chain of command to develop and implement contracting strategy with various types of providers/facilities across the Health Plan service area. Evaluates and negotiates physician, ancillary and hospital contracts, including contract language and reimbursement methodologies for fee for service arrangements. Prepares standard accurate agreements to formalize such arrangements. Ability to identify data needed to evaluate and develop network reimbursement proposals to develop arrangements advantageous to our members and Health Plan. Calls upon team analysts for support.

Works directly with team analysts and other department managers to understand how the negotiated agreement is translated into the company's systems. Prepares timely and accurate communications to other departments for loading finalized agreements into production. Assists with internal audit of provider records to ensure accurate reimbursement. Serve as liaison to other departments on contract and reimbursement interpretation issues and ensures timely turnaround.

Must have strong knowledge of the Health Plan's end-to-end provider engagement processes, including interdepartmental handoffs as well as plan policies and procedures to ensure the best possible provider experience. Manage or participate in project work as assigned. May be called upon to assist in network education, onboarding and overall network relationship building.

Qualifications

Bachelor’s degree is or the equivalent experience preferred in the areas of finance, business, health care administration or communications preferred but willing to waive with strong work experience.

Prior experience working with health care insurance or insurance network management, on commercial and/or government network reimbursement methodologies. Previous experience with behavioral health care reimbursement is a plus.

Experienced in analyzing, understanding, communicating, and negotiating financial impact of contract terms, payment structures and reimbursement rates with providers. Proficiency with contract reading and redlining.

Proficiency in MS Office applications.

Ability and willingness for occasional travel, including overnights, which may include holding face to face meetings at the Health Plan offices, provider offices or attending conferences.

Work at Home/Remote Requirements must ensure designated work area is free from distractions during work hours and virtual meetings, and must provide a high-speed DSL or cable modem for a workspace.

Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to [e-mail] .

Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

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