Provider Network Contractor II

Medica Services Company LLC; Minnetonka (MN); On-site; USD 70,200 - 105,315; Full time

Benefits offered by this job

Medical, dental, vision benefits

PTO and holidays

401K contributions

Volunteer time off

Caregiver services

Job summary

Medica Services Company LLC, a nonprofit health plan serving Minnesota and surrounding states, seeks a Provider Network Manager to develop and maintain a competitive provider network and manage cost performance and trend reporting.

You will negotiate contracts, build strong relationships with hospitals, physicians, and other providers, and ensure adherence to templates and reimbursement standards. This on-site role offers a comprehensive rewards package.

Qualifications

• Bachelor's degree or equivalent experience in healthcare management/administration or healthcare related field.
• Experience of 3+ years in health insurance/healthcare.

Responsibilities

• Develop and maintain provider network yielding a competitive, geographic, stable network that achieves objectives for performance and growth.
• Evaluates and negotiates contracts in compliance with company contract templates, and reimbursement structure standards.
• Builds and maintains positive relationships with providers.
• Communicates contract terms and provisions to provider and internal staff.
• Updates and maintains contract tracking system and contracting calendar within timeframes.

Skills

Managed care knowledge

Provider network administration

Contract negotiation

Attention to detail

Customer service

Education

Bachelor's degree in healthcare management/administration

Tools

Microsoft Word

Excel

Outlook

Job description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

Develop and maintain provider networks yielding a competitive, geographic, stable network that achieves objectives for unit cost performance and trend management. Produces an affordable and predictable network for customers and business partners. Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties. Performs other duties as assigned.

Key Accountabilities:

• Develop and maintain provider network yielding a competitive, geographic, stable network that achieves objectives for performance and growth.
• Evaluates and negotiates contracts in compliance with company contract templates, and reimbursement structure standards.
• Builds and maintains positive relationships with providers.
• Processes and negotiates needed provider contract amendments and assignments as requested; and communicates contract terms and provisions to provider and all needed internal staff.
• Updates and maintains contract tracking system, records information sharing system and contracting calendar within contract metric timeframes.

Qualifications:

• Bachelor's degree or equivalent experience in healthcare management/administration or healthcare related field
• Plus 3 years of work experience in health insurance/healthcare field

Skills and Abilities:

• Strong knowledge of managed care products, e.g. HMO, POS, PPO and provider network administration
• Health plan negotiation experience preferred
• Expertise working with Microsoft Word, Excel, and Outlook
• High level of attention to detail and customer service
• Maintain regularly assigned work schedule

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, St. Louis, MO, or Omaha, NE.

The full salary grade for this position is $70,200 - $120,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $70,200 - $105,315. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US:Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.