Strategic Network Contracts Analyst

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

Job summary

Capital District Physicians Health Plan Inc is seeking a professional to support the development and maintenance of provider networks within the network contracting and administration team. The role focuses on provider reimbursement evaluation and contract negotiations aligned with corporate strategy.

The candidate should bring expertise in provider types, regulatory requirements, pricing methodologies, and regional market dynamics to deliver accurate analyses and actionable recommendations to

Qualifications

• Six (6) years of provider network reimbursement or related experience.
• Two (2) years of experience directly performing 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.
• Serves as provider network contracting and administration subject matter expert for assigned areas.
• 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.
• Prepares and presents information, findings, and recommendations to internal and external stakeholders.
• Liaises with stakeholders to coordinate contract and administration work items; tracks progress and reports on outcomes.

Skills

Communication skills

Financial modeling

Contract interpretation

Education

Bachelor's degree in Health Care Administration or relevant field

Job description

Capital District Physicians Health Plan Inc is seeking a professional to support the development and maintenance of provider networks within the network contracting and administration team. The role focuses on provider reimbursement evaluation and contract negotiations aligned with corporate strategy.

The candidate should bring expertise in provider types, regulatory requirements, pricing methodologies, and regional market dynamics to deliver accurate analyses and actionable recommendations to