Provider Network Contracts & Analysis Specialist

Excellus BCBS; City of Utica (NY); Hybrid; USD 62,000 - 107,000; Full time

Benefits offered by this job

Remote work option

Job summary

Excellus BCBS in Utica, NY is seeking a seasoned professional for network contracting and administration. You will contribute to development and maintenance of provider networks, perform provider and network analysis, evaluate reimbursement, and negotiate contracts in alignment with corporate strategy.

This role requires understanding provider types, regulatory requirements, pricing methodologies, industry trends, and regional market dynamics.

Qualifications

• Six years of provider network reimbursement or related experience.
• Two years of provider contracting or reimbursement analysis.
• 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.

Responsibilities

• Establishes and maintains network adequacy across regions and lines of business.
• Analyses, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies.
• Collects and interprets data to support provider network contracting and administration; applies regulatory requirements to produce actionable analysis.
• Prepares and presents information, findings, and recommendations to stakeholders.
• Liaises with stakeholders to coordinate provider network contract and administration work items; tracks progress and reports on metrics.
• Engages in provider contract negotiations with providers, clinical, and operational leadership.
• Assists in preparation of provider contracts, amendments, communications.
• Maintains knowledge of legislative and regulatory mandates to ensure compliance.
• Responds to inquiries from providers and colleagues and resolves issues.
• Maintains high standards of integrity and privacy according to policies.
• Regular attendance and other duties as assigned.

Skills

Provider reimbursement

Contract analysis

Financial modeling

Data interpretation

Verbal and written communication

Education

Bachelor's degree in Health Care Administration or relevant field

Job description

Excellus BCBS in Utica, NY is seeking a seasoned professional for network contracting and administration. You will contribute to development and maintenance of provider networks, perform provider and network analysis, evaluate reimbursement, and negotiate contracts in alignment with corporate strategy.

This role requires understanding provider types, regulatory requirements, pricing methodologies, industry trends, and regional market dynamics.