Provider Relations Contracting and Network Specialist

US Family Health Plan- A TRICARE Prime option; New York (NY); Hybrid; USD 85,000 - 90,000; Full time

Benefits offered by this job

Medical benefits

Vision and dental coverage

401(k) retirement plan with employer 1

Paid holidays

Job summary

SVCMC, Inc. is seeking a Provider Contract Specialist to initiate and manage relationships with hospitals, clinics, and ancillary providers in a hybrid New York setting. You will analyze business needs, ensure compliance with plan policies, and support network development with internal teams.

The role requires 2–5 years in provider contracting, strong analytical abilities, and proficiency with MS Office and Salesforce. Hybrid schedule offered with in-office and remote days.

Qualifications

• BA/BS degree required.
• 2–5 years of provider contracting experience.
• Experience with value-based contracting is a plus.

Responsibilities

• Review, analyze, negotiate, implement, and maintain contracts with understanding of rate schedules and language.
• Identify network development opportunities through financial analysis and client requests.
• Define performance improvement opportunities.
• Assist with provider applications for completeness and timeliness per guidelines.
• Assist with provider orientation and training.
• Coordinate cross-departmental resolution of contracting issues.

Skills

Contract negotiation

Analytical skills

MS Office

SalesForce

Detail oriented

Education

BA/BS

Tools

SalesForce

Job description

Job Summary

Initiates dialog with prospective providers/ancillary providers (including, but not limited to, hospitals, skilled nursing facilities, skilled home healthcare agencies, and ambulatory surgical centers) based on business needs. Service providers to facilitate provider understanding of Plan Policies and Contractual Requirements. Develop and maintain positive working relationships with participating providers. Conduct analysis of business need and maintains network in compliance with business need; collaborates with marketing/sales and family practice center staff.

Responsibilities

• Review, analyze, negotiate, implement, and maintain existing contracts with an understanding of professional rate schedules and contractual language.
• Identify network development opportunities through financial analysis, client requests, and product development.
• Define performance improvement opportunities.
• Assist with initial applications for completeness, timeliness, and accuracy in accordance with established guidelines.
• Assist with provider orientation and training.
• Facilitate interdepartmental collaboration to resolve complex provider issues related to contracting and contract configuration.
• Manages territory, inclusive of strategic network partnerships and the Plan's family health centers.
• Provides general instruction and support on USFHP products, provider manual, provider directory, Plan policies and Plan procedures.
• Research, resolve, and respond to provider/ancillary provider inquiries including, but not limited to, participation requirements, credentialing requirements, credentialing status, contract terms, fee schedules, reimbursement, utilization, access/availability standards, member eligibility, consult report requirements, etc.
• Document and track inquiries received and resolution.
• Monitor contract performance through site visits, claims and data analysis.
• Monitor quality and regulatory compliance and participate in annual HEDIS activities.
• Assist with Provider Panel Report Cards and Scorecard
• All other duties as assigned by management

Years Of Experience

• min. of 2 years’ experience in a provider contracting role with existing marketing relationships; experience with value based contracting a plus.
• 3- 5 years’ experience working with providers including medical groups, ancillary vendors, and allied health professionals.

Technical Skills/Competencies

• Familiar with various reimbursement models including DRG, fee for service, bundle payments, etc.
• Industry payment rules, billing, coding, etc. a plus.
• Proficiency in Microsoft Office (2010) Word, Excel, PowerPoint, and Access.
• Must be organized and detail oriented.
• Ability to meet stringent deadlines and adjust priorities with business needs.
• Ability to reprioritize and adjust workload.
• Excellent communication & analytical skills.
• Experience with SalesForce.

EDUCATION/CERTIFICATION/LICENSE

• BA/BS required

SALARY RANGE: $85,000.00-$90,000.00

Benefits Statement

• SVCMC, Inc. provides a robust benefits package that includes medical coverage through UnitedHealthcare/Oxford with no deductible for in-network services.
• Employees also receive vision coverage through UnitedHealthcare Vision and dental benefits through MetLife.
• Basic life and disability insurance are automatically provided at no cost.
• All employees are eligible for commuter benefits, tuition reimbursement, and a 401(k)retirement plan with an immediate employer match that is fully vested from day one.
• SVCMC also offers a generous time off package, which includes vacation, 10 paid holidays, and 3 personal days.
• Additionally, employees have access to a comprehensive Employee Assistance Program and exclusive discounts through Working Advantage.

Equal Opportunity Employer Statement

SVCMC IS AN EQUAL OPPORTUNITY EMPLOYER – ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO VETERAN STATUS, DISABILITY, OR OTHER CHARACTERISTICS PROTECTED BY LAW.

HYBRID Work Schedule

Mondays & Fridays Remote. Tuesdays through Thursdays in office. 8:30 am - 4:30 pm