Provider Contracts Specialist - Health Plan

Sanford Health; Wisconsin; 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 negotiating agreements, collaborating with teams, and ensuring compliance with reimbursement methodologies. The position is primarily remote but requires occasional in-person attendance for meetings and training. The ideal candidate will have a strong background in healthcare administration and contract negotiation skills. A comprehensive benefits package is offered.

Benefits

Health insurance

Dental insurance

Vision insurance

Life insurance

401(k)

Generous time off

Qualifications

• Prior experience with healthcare insurance or network management required.
• Proficient in analyzing, understanding, communicating, and negotiating financial aspects of contracts.

Responsibilities

• Responsible for maintaining, coordinating, and establishing pricing arrangements.
• Evaluating and negotiating physician, ancillary, and hospital contracts.
• Preparing accurate agreements and acting as a liaison for contract issues.

Skills

Negotiation

Communication

Analysis

Education

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

Tools

MS Office

Job description

Provider Contracts Specialist - Health Plan | Sanford Careers

Sanford Health

Provider Contracts Specialist - Health Plan Remote, Wisconsin

Location: Remote, WI

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

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 a key role in building and maintaining high-value, compliant networks, which may involve provider recruitment activities. They work directly with management to develop and implement contracting strategies with various providers and facilities. Responsibilities include evaluating and negotiating physician, ancillary, and hospital contracts, including contract language and reimbursement methodologies for fee-for-service arrangements, and preparing accurate agreements.

The PCS must identify data needed to evaluate and develop network reimbursement proposals that benefit members and the Health Plan. They collaborate with team analysts for support and understand how negotiated agreements are integrated into company systems. They prepare communications for other departments to load finalized agreements and assist with internal audits to ensure accurate reimbursements. The role acts as a liaison to interpret contracts and reimbursement issues, ensuring timely responses.

Qualifications

Bachelor’s degree or equivalent experience is preferred in finance, business, healthcare administration, or communications, but strong work experience may suffice. Prior experience with healthcare insurance or network management, including reimbursement methodologies, is required. Experience with behavioral health reimbursement is a plus. Candidates should be proficient in analyzing, understanding, communicating, and negotiating financial aspects of contracts, with skills in contract reading and redlining. Proficiency in MS Office is required. Ability and willingness to travel occasionally, including overnight stays, is necessary. For remote work, a dedicated, distraction-free workspace and high-speed internet are required.

Sanford Health offers a comprehensive benefits package, including health, dental, vision insurance, life insurance, a 401(k), work/life balance benefits, and generous time off. For more details, visit https://sanfordcareers.com/benefits.

Sanford is an EEO/AA Employer. Accommodations for applicants with disabilities are available upon request. The workplace maintains a drug-free policy, requiring drug screening and background checks for employment.

Req Number: R-0220493

Job Function: Legal and Compliance