Provider Contracts Specialist - Health Plan

Sanford Health; South Dakota; Remote; Full time

Job summary

A leading health system is seeking a Provider Contracts Specialist to manage provider contracts and pricing arrangements. This remote role involves negotiating contracts, analyzing reimbursement proposals, and collaborating with various departments. Ideal candidates will have a Bachelor's degree and experience in healthcare insurance. The position offers competitive pay and a comprehensive benefits package.

Benefits

Health Insurance

Dental Insurance

Vision Insurance

401(k)

Generous Paid Time Off

Qualifications

• Experience with healthcare insurance or network management preferred.
• Ability to analyze and negotiate contract terms.

Responsibilities

• Maintain and coordinate pricing arrangements with provider groups.
• Evaluate and negotiate contracts with leadership support.

Skills

Negotiation

Communication

Analysis

Education

Bachelor’s degree

Tools

MS Office

Job description

Provider Contracts Specialist - Health Plan | Sanford Careers

Sanford Health

Provider Contracts Specialist - Health Plan Remote, South Dakota

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

Facility: Remote SD (Central Time)

Location: Remote, SD

Shift: Varies

Job Schedule: Full time

Weekly Hours: 40.00

Salary Range: $24.00 - $38.50

This position is primarily remote, with some in-person attendance for trainings, team meetings, or special projects, scheduled in advance.

Job Summary

The Provider Contract Specialist (PCS) maintains, coordinates, and establishes pricing arrangements involving provider groups, facilities, and ancillary entities joining the Health Plan networks. Responsibilities include creating standard contracts, building and maintaining high-value, compliant networks, and possibly engaging in provider recruitment activities. The PCS works with leadership to develop contracting strategies, evaluates and negotiates contracts, and prepares accurate agreements. They identify data needs for developing reimbursement proposals and support system integration and communication with other departments. The role requires understanding of the health plan's provider engagement processes, policies, and procedures, and may involve project work, 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, especially in behavioral health, is a plus.
• Ability to analyze, communicate, and negotiate contract terms and reimbursement rates; proficiency in contract reading and redlining.
• Proficiency in MS Office applications.
• Willingness for occasional travel, including overnight trips.
• Work-from-home setup must be distraction-free with high-speed internet.

Sanford Health offers an attractive benefits package including health, dental, vision, life insurance, 401(k), work/life balance benefits, and generous paid 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 can be requested by calling 1-877-673-0854 or emailing [e-mail].

Employment requires passing a drug screen and background check. Req Number: R-0220493 | Job Function: Legal and Compliance