Provider Network Contract & Reimbursement Specialist

Lifetime Workforce Solutions, LLC; City of Rochester (NY); Hybrid; USD 62.000 - 107.000; Vollzeit

Zusammenfassung

Univera Healthcare in Rochester, NY seeks a provider network reimbursement professional to establish and maintain network adequacy, analyze reimbursement, and support contracting and administration. You will collaborate with providers and leadership to implement strategies within budgets and regulatory guidelines.

The role requires six years of relevant experience or a bachelor’s degree, plus two years in contracting/reimbursement analysis, with strong modeling, financial analysis, and contract

Qualifikationen

• Six (6) years of provider network reimbursement or related experience required or a Bachelor's degree in Health Care Administration or relevant field.
• Two (2) years of experience directly performing provider contracting or reimbursement analysis required.
• Demonstrated experience of provider reimbursement methodologies.
• Ability to draft, interpret and apply contractual language.
• Technical skills including modeling and financial analysis.
• Understanding of medical care delivery, industry trends, and regional market dynamics.
• Strong, persuasive, and effective verbal and written communication skills.

Aufgaben

• Establishes and maintains network adequacy for assigned provider types, regions and/or lines of business.
• Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies.
• Identifies, investigates, and analyzes issues and questions related to provider network contracting and administration.
• Effectively prepares and presents information, findings, and recommendations to stakeholders.
• Serves as liaison with stakeholders to coordinate provider network contract and administration work items.
• Engages in provider contract negotiations with providers, clinical, and operational leadership.
• Assist in the preparation of provider contracts, amendments, and communications.
• Maintains knowledge of regulatory mandates to ensure compliance.
• Responds to inquiries from providers and colleagues and leads issue resolution.

Kenntnisse

Financial modeling

Financial analysis

Contract interpretation

Communication skills

Ausbildung

Bachelor's degree in Health Care Administration or relevant field

Jobbeschreibung

Univera Healthcare in Rochester, NY seeks a provider network reimbursement professional to establish and maintain network adequacy, analyze reimbursement, and support contracting and administration. You will collaborate with providers and leadership to implement strategies within budgets and regulatory guidelines.

The role requires six years of relevant experience or a bachelor’s degree, plus two years in contracting/reimbursement analysis, with strong modeling, financial analysis, and contract