Remote Provider Network Contracts Analyst

Capital District Physicians Health Plan Inc; Town of De Witt (NY); On-site; USD 62,000 - 107,000; Full time

Job summary

Capital District Physicians Health Plan Inc. in the New York Capital District region seeks a Network Contracting and Administration professional to support development and maintenance of provider networks, reimbursement analysis, and contract negotiations within corporate strategy.

The role requires understanding contract terms, pricing methodologies, and regulatory requirements to deliver compliant contracting solutions.

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.
• 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.
• Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies.
• Identifies, investigates and analyzes issues and questions; collects and interprets data to support contracting activities.
• Effectively prepares and presents information, findings and recommendations to internal and external stakeholders.
• Serves as liaison with assigned stakeholders to identify and coordinate provider network contract and administration work items.
• Executes initiatives; tracks, forecasts and reports on progress including qualitative and quantitative measures.
• Engages in provider contract negotiations with providers, clinical and operational leadership.
• Assist in the preparation of provider contracts, amendments, and communications.
• Maintains knowledge of regulatory mandates to ensure compliance.
• Responds to inquiries from providers and leads issue resolution with stakeholders.

Skills

Provider reimbursement

Financial modeling

Regulatory compliance

Contract drafting

Data interpretation

Verbal communication

Education

Bachelor's degree in Healthcare Administration

Relevant field

Job description

Capital District Physicians Health Plan Inc. in the New York Capital District region seeks a Network Contracting and Administration professional to support development and maintenance of provider networks, reimbursement analysis, and contract negotiations within corporate strategy.

The role requires understanding contract terms, pricing methodologies, and regulatory requirements to deliver compliant contracting solutions.