Provider Contracts Specialist - Health Plan

Sanford Health; Sioux Falls (SD); Hybrid; Full time

Job summary

A leading healthcare provider is seeking a Provider Contracts Specialist to manage and establish pricing arrangements with healthcare providers. This role involves developing contracting strategies, negotiating contracts, and ensuring compliance within the Health Plan networks. The position offers remote work flexibility with occasional in-person requirements for meetings and training.

Qualifications

• Experience with healthcare insurance or network management.
• Ability to analyze and negotiate financial impacts of contracts.

Responsibilities

• Develop and implement contracting strategies with providers.
• Evaluate and negotiate physician and hospital contracts.
• Serve as a liaison on contract and reimbursement issues.

Skills

Negotiation

Communication

Analysis

Education

Bachelor’s degree

Tools

MS Office

Job description

Provider Contracts Specialist - Health Plan

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.

Work Shift: Varies (United States of America)

Scheduled Weekly Hours: 40

Salary Range: $24.00 - $38.50

Union Position: No

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.

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 service area. The PCS plays an integral role in building and maintaining high-value, compliant networks, which may involve provider recruitment activities.

Job Description

• Develop and implement contracting strategies with various providers and facilities across the service area, working directly with the chain of command.
• Evaluate and negotiate physician, ancillary, and hospital contracts, including contract language and reimbursement methodologies for fee-for-service arrangements.
• Prepare standard, accurate agreements to formalize arrangements.
• Identify data needed to evaluate and develop network reimbursement proposals that benefit members and the Health Plan, calling upon team analysts for support.
• Coordinate with team analysts and other managers to ensure negotiated agreements are accurately translated into company systems.
• Communicate effectively with other departments for loading finalized agreements and assist with internal audits of provider records to ensure accurate reimbursement.
• Serve as a liaison on contract and reimbursement issues, ensuring timely responses.
• Maintain a strong knowledge of the Health Plan's provider engagement processes, policies, and procedures to enhance the provider experience.
• Participate in or manage project work as assigned, including network education, onboarding, and relationship building.

Qualifications

• Bachelor’s degree or equivalent experience preferred in finance, business, healthcare administration, or communications; strong work experience may suffice.
• Experience with healthcare insurance or network management, including reimbursement methodologies for commercial and/or government plans. Behavioral health care reimbursement experience is a plus.
• Ability to analyze, understand, communicate, and negotiate financial impacts of contracts and payment structures.
• Proficiency in reading and redlining contracts, MS Office applications, and willingness to travel occasionally, including overnight stays.
• Work at Home/Remote: Must have a dedicated workspace free from distractions and high-speed internet access.

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].

About the company

Sanford Health, one of the largest health systems in the US, is dedicated to healthcare delivery, genomic medicine, senior care, global clinics, research, and affordable insurance.