Provider Contracts Specialist - Health Plan

Good Samaritan Society; Wisconsin; Hybrid; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Provider Contracts Specialist to join their remote team in Wisconsin. This role is pivotal in maintaining and coordinating pricing arrangements with healthcare providers, ensuring compliance and high-value networks. You will engage in contract negotiation, financial analysis, and work closely with various departments to integrate agreements into company systems. The ideal candidate will have a strong background in healthcare insurance or network management, along with excellent communication skills. Join a company that values work-life balance and offers a comprehensive benefits package, making a significant impact in the healthcare landscape.

Benefits

Health insurance

Dental insurance

Vision insurance

401(k) plan

Work/life balance benefits

Qualifications

• Bachelor's degree or equivalent experience preferred in finance, business, or healthcare administration.
• Experience with healthcare insurance or network management is essential.

Responsibilities

• Maintain and coordinate pricing arrangements involving provider groups and facilities.
• Evaluate and negotiate contracts, ensuring accurate agreements and reimbursements.

Skills

Contract negotiation

Financial analysis

Communication

MS Office proficiency

Education

Bachelor’s degree in finance or business

Equivalent experience in healthcare administration

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 contracts, including language and reimbursement methodologies, and preparing accurate agreements. The PCS must identify necessary data to evaluate and develop network reimbursement proposals that benefit members and the Health Plan, calling upon team analysts for support.

The role involves working with analysts and other departments to ensure negotiated agreements are correctly integrated into company systems, and assisting with internal audits to ensure accurate reimbursements. The PCS acts as a liaison for contract and reimbursement issues, ensuring timely responses. They must understand the provider engagement process, plan policies, and procedures to ensure a positive provider experience. The role may also involve participating in projects, 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 aspects of contracts and reimbursement rates. Proficiency in contract reading and redlining.
• Proficiency with MS Office applications.
• Willingness and ability to travel occasionally, including overnight stays, for meetings and conferences.
• Remote work requires a dedicated, distraction-free workspace and high-speed internet.

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

Sanford is an EEO/AA Employer/M/F/Disability/Vet. Accommodations for applicants with disabilities can be requested via phone or email. Sanford maintains a Drug-Free Workplace policy, with pre-employment screening required.

Req Number: R-0220493
Job Function: Legal and Compliance