Provider Contracts Specialist - Health Plan

Sanford Health; United States; Remote; Full time

Job summary

A leading healthcare organization is seeking a Provider Contracts Specialist to manage pricing arrangements and contracts with providers. This role involves developing strategies, negotiating contracts, and ensuring compliance within the health plan networks. The position offers remote work flexibility with occasional onsite requirements for meetings and training.

Qualifications

• Experience with healthcare insurance or network management.
• Ability to read and redline contracts proficiently.

Responsibilities

• Develop and implement contracting strategies with providers.
• Evaluate and negotiate contracts, including reimbursement methodologies.
• Collaborate with team analysts for contract development.

Skills

Negotiation

Contract Analysis

Communication

Education

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

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 Health Plan service area and playing an integral role in building and maintaining high-value, compliant networks, which may involve provider recruitment activities.

Job Responsibilities

• Develop and implement contracting strategies with various providers and facilities across the service area.
• 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.
• Collaborate with team analysts to support contract development and system integration.
• Ensure accurate loading of finalized agreements into company systems and assist with internal audits to verify reimbursement accuracy.
• Serve as a liaison to other departments on contract and reimbursement issues, ensuring timely responses.
• Manage or participate in project work, 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 be considered in lieu of a degree.
• Experience with healthcare insurance or network management, including reimbursement methodologies for commercial and/or government payers. Experience with behavioral health reimbursement is a plus.
• Proficiency in analyzing, understanding, and negotiating contract terms and reimbursement rates.
• Ability to read and redline contracts proficiently.
• Proficiency in MS Office applications.
• Willingness to travel occasionally, including overnight stays, for meetings and conferences.
• Must have a dedicated, distraction-free remote workspace and high-speed internet connection.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you require accommodation during the application process, please call 1-877-673-0854 or email [e-mail].

About Sanford Health

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