Remote-Eligible Provider Network Contract Analyst

Capital District Physicians’ Health Plan, Inc.; City of Rochester (NY); Hybrid; USD 62,000 - 107,000; Full time

Job summary

Capital District Physicians’ Health Plan, Inc. seeks a professional in the network contracting and administration team to develop and maintain provider networks, evaluate provider reimbursement, and negotiate contracts aligned to strategy.

The role requires expertise in provider types, regulatory requirements, pricing methodologies, and regional market dynamics, with strong data interpretation and stakeholder communication. Remote work opportunities may apply case-by-case.

Qualifications

• Six years of provider network reimbursement or related experience.
• Two years of provider contracting or reimbursement analysis.
• Demonstrated experience with 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 verbal and written communication skills.
• Knowledge of health care products and services offered to members.
• Excellent problem-solving skills.

Responsibilities

• Establishes and maintains network adequacy for assigned provider types, regions and/or lines of business.
• Serves as provider network contracting and administration subject matter expert.
• Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and strategies.
• Identifies, investigates, and analyzes issues; collects and interprets data to support contracting activities.
• Applies contract terms, regulatory requirements to produce accurate analysis.
• Prepares and presents information, findings, and recommendations to stakeholders.
• Acts as liaison with stakeholders to coordinate contract and administration work items.
• Executes initiatives; tracks, forecasts and reports progress with qualitative and quantitative measures.
• Engages in provider contract negotiations with providers and leadership.
• Assists in preparing provider contracts, amendments, and communications.
• Maintains knowledge of relevant legislative and regulatory mandates for compliance.
• Responds to inquiries from providers and colleagues and leads issue resolution.
• Upholds integrity aligned with mission and values; protects member privacy.
• Maintains attendance as required.
• Performs other functions as assigned by management.

Skills

Provider network reimbursement

Contracting analysis

Financial analysis

Communication skills

Problem-solving

Education

Bachelor's degree in Health Care Administration or relevant field

Job description

Capital District Physicians’ Health Plan, Inc. seeks a professional in the network contracting and administration team to develop and maintain provider networks, evaluate provider reimbursement, and negotiate contracts aligned to strategy.

The role requires expertise in provider types, regulatory requirements, pricing methodologies, and regional market dynamics, with strong data interpretation and stakeholder communication. Remote work opportunities may apply case-by-case.