Provider Contracts Specialist - Health Plan

Sanford Research; South Dakota; Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Provider Contracts Specialist to join their dynamic team. This role involves managing and negotiating contracts with healthcare providers, ensuring compliance, and optimizing reimbursement structures. The ideal candidate will possess strong analytical skills and a deep understanding of healthcare administration. With a commitment to health and healing, this organization offers a collaborative environment where your contributions will have a meaningful impact on the community. If you're ready to take on a rewarding challenge in a supportive setting, this opportunity is perfect for you.

Benefits

Health Insurance

401(k) Retirement Plan

Paid Time Off

Employee Discounts

Voluntary Benefits

Qualifications

• Bachelor’s degree or equivalent experience preferred in finance or healthcare.
• Experience with healthcare insurance or network management is essential.

Responsibilities

• Coordinate pricing arrangements and maintain provider contracts.
• Negotiate contract terms and reimbursement methodologies.

Skills

Contract Negotiation

Financial Analysis

Health Care Administration

Communication Skills

MS Office Proficiency

Education

Bachelor’s Degree in Finance or Business

Equivalent Experience

Job description

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

Sanford Health

Sanford Health Provider Contracts Specialist - Health Plan Remote, South Dakota

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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.

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Health Insurance

We offer multiple health plan options allowing you flexibility to choose what fits best for your family.

Paid Time Off

With our paid time off program we encourage you to take time away to re-charge and re-fresh.

Voluntary Benefits

A large assortment of voluntary benefits allow you to customize your benefit package.

Company Paid Benefits

Eligible employees receive base life insurance and disability at no cost to help with financial needs.

401(k) Retirement Savings Plan

We provide a generous employer match contribution while you put away money for your retirement.

Employee Perks

Employees get access to a wide selection of discounts/perks both local and nationwide.

Job Details

Careers With Purpose

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 SD (Central Time)

Location: Remote, SD

Address

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

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.

Benefits

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

Apply Now

Current Employees Apply Here

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