Provider Network Contracts Specialist (Hybrid)

Enlightened, Inc.; Washington (District of Columbia); Hybrid; USD 92,800 - 126,400; Full time

Benefits offered by this job

Medical/Dental/Vision Insurance

HSA (Health Savings Account)

401(k) Retirement Plan

Professional Training & Development

Job summary

Enlightened, Inc. is seeking a Provider Network Management Contractor in Washington, DC.

The hybrid role requires coordinating in-office and remote work four days on-site and one day remote weekly, with responsibilities including contracting and re-contracting healthcare providers and aligning agreements with regulatory standards. The candidate will negotiate contracts, manage provider relationships, and support network growth while ensuring compliance and aligning with HEDIS, CAHPS, NCQA, and

Qualifications

• Associate degree required.
• Bachelor's degree preferred.
• Master's degree strongly preferred.

Responsibilities

• Support provider network development strategy.
• Negotiate provider contracts to ensure compliant, competitive networks.
• Negotiate SCAs and transition providers into contracted network.
• Collaborate to execute annual contracting strategy and expand the network.
• Provide SME guidance on reimbursement methodologies and fee schedules.

Skills

Negotiation

Relationship-building

Financial analysis

Communication

MS Office

Education

Associate's degree

Bachelor's degree

Master's degree

Job description

Enlightened, Inc. is seeking a Provider Network Management Contractor in Washington, DC.

The hybrid role requires coordinating in-office and remote work four days on-site and one day remote weekly, with responsibilities including contracting and re-contracting healthcare providers and aligning agreements with regulatory standards. The candidate will negotiate contracts, manage provider relationships, and support network growth while ensuring compliance and aligning with HEDIS, CAHPS, NCQA, and