Sr. Hospital Contracting Specialist

Sacbar; Tallahassee, Northern (FL, KY); Hybrid; USD 120,000 - 180,000; Full time

Job summary

Sacbar is seeking a Senior Hospital Contracting Strategist to initiate, negotiate, and execute provider contracts for our health insurance organization. You will lead hospital and health system negotiations, oversee reimbursement terms, and collaborate across Finance, Legal, and Network Management to ensure financially sound agreements.

The role requires strong Medicare negotiation experience, leadership in complex contracts, and a track record in managed care.

Qualifications

• Bachelor's degree in a relevant field.
• 5+ years hospital negotiation experience in Medicare.
• Leading negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements.
• 5+ years progressive network management including hospital contracting.
• Experience negotiating managed care contracts with Hospital systems inclusive of post acute, ancillary providers and physicians.
• Analyze, understand and communicate financial impact of contract terms, payment structures and reimbursement rates to providers.
• Understand and interpret Hospital contract language.
• Proficient in Microsoft Office: Word, Excel and PowerPoint.

Responsibilities

• Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements.
• Extensive managed care experience with demonstrated expertise in hospital contracting, reimbursement methodologies, financial analysis, complex negotiations, provider relationship management, and leadership.
• Experience with Medicare Advantage, Medicaid, and value based-contracting.
• Evaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangements; partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable.
• Communicate contract terms, payment structures, and reimbursement rates to providers.
• Analyze financial impact of contracts and terms.
• Maintain contracts and documentation within a tracking system.
• Help with identifying and recruiting providers based on network composition and needs.

Skills

Hospital negotiations

Managed care

Financial analysis

Provider relations

Leadership

Medicare Advantage

Value-based contracting

Contract language

MS Office

Education

Bachelor's degree

Master's degree

Tools

Word

Excel

PowerPoint

Job description

The Senior Hospital Contracting Strategist / Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital and other provider contracts and agreements for an organization that provides health insurance. You will report to the Director, Provider Contracting.

As the Senior Hospital Contracting Strategist/ Senior Provider Contracting Professional you will

• Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
• Extensive managed care experience with demonstrated expertise in hospital contracting, reimbursement methodologies, financial analysis, complex negotiations, provider relationship management, and leadership
• Experience with Medicare Advantage, Medicaid, and value based-contracting
• Evaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangements
  Partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable
• Communicate contract terms, payment structures, and reimbursement rates to providers
• Analyze financial impact of contracts and terms
• Maintain contracts and documentation within a tracking system
• Help with identifying and recruiting providers based on network composition and needs

Required Qualifications

• Bachelor's degree
• 5 or more years of Hospital negotiation experience in Medicare
• Leading negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
• 5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company
• Experienced in negotiating managed care contracts with Hospital systems inclusive of post acute, ancillary providers and physicians.
• Analyze, understand and communicate financial impact of contract terms, payment structures and reimbursement rates to providers.
• Understand and interpret Hospital contract language
• Proficient in Microsoft Office: Word, Excel and PowerPoint
  

Preferred Qualifications

• Master's Degree
• Experience with ACO/Risk Contracting
• Experience with Value Based Contracting