Remote Network Contracts & Reimbursement Analyst

Univera Healthcare; City of Rochester (NY); On-site; USD 62,000 - 107,000; Full time

Benefits offered by this job

Remote work possibility

Competitive compensation

Job summary

Univera Healthcare's network contracting and administration team seeks a seasoned professional to develop and maintain provider networks, evaluate reimbursement, and negotiate contracts in line with corporate strategy.

You will analyze data, prepare recommendations, draft agreements, and collaborate with providers and leadership to ensure network adequacy, regulatory compliance, and market alignment.

Qualifications

• Six (6) years in provider network reimbursement or related area or Bachelors degree in Health Care Administration or relevant field
• Two (2) years directly performing provider contracting or reimbursement analysis
• Experience with provider reimbursement methodologies
• Ability to draft, interpret and apply contractual language
• Strong financial modeling and analysis skills
• Understanding of medical care delivery, industry trends, and regional market dynamics
• Excellent verbal and written communication skills
• Knowledge of health care products and services offered to members
• Strong problem-solving abilities

Responsibilities

• Establishes and maintains network adequacy for assigned provider types, regions and lines of business.
• Analyses, develops, and proposes formal provider reimbursement recommendations within budgets and strategy.
• Collects and interprets data to support provider network contracting activities and ensures compliance with terms and regulations.
• Prepares and presents findings and recommendations to internal and external stakeholders.
• Coordinates with stakeholders to identify and manage provider network contract and administration tasks.
• Engages in provider contract negotiations with providers and leadership.
• Assists in preparing provider contracts, amendments, and communications.
• Maintains knowledge of regulatory mandates to ensure compliance.
• Responds to inquiries from providers and colleagues and leads issue resolution.
• Adheres to corporate codes and Lifetime Way values; protects member privacy.
• Performs other duties as assigned.

Skills

Provider network analysis

Reimbursement methodologies

Contract drafting & interpretation

Data interpretation and financial分析

Verbal & written communication

Regulatory compliance knowledge

Education

Bachelor's degree in Health Care Administration or relevant field

Job description

Univera Healthcare's network contracting and administration team seeks a seasoned professional to develop and maintain provider networks, evaluate reimbursement, and negotiate contracts in line with corporate strategy.

You will analyze data, prepare recommendations, draft agreements, and collaborate with providers and leadership to ensure network adequacy, regulatory compliance, and market alignment.