Strategic Network Contracts Analyst

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

Benefits offered by this job

Remote work option

Job summary

Capital District Physicians Health Plan Inc (CDPHP) is seeking a network contracts professional to support the development and maintenance of provider networks and to negotiate provider contracts in alignment with corporate strategy.

The role requires expertise in provider reimbursement analysis, pricing methodologies, and regulatory compliance, with collaboration across clinical, network, and operations leadership to drive program success.

Qualifications

• Six or more years in provider network reimbursement or related experience.
• At least two years performing provider contracting or reimbursement analysis.
• 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; acts as SME for network contracting and administration.
• Analyzes, develops, and proposes formal provider reimbursement recommendations within budgets and strategy.
• Collects and interprets data to support contracting and administration activities; applies regulatory requirements to analyses.
• Prepares and presents information, findings, and recommendations to stakeholders.
• Coordinates with stakeholders to identify and manage network contract work items; tracks progress and reports it.
• Engages in provider contract negotiations with providers and leadership teams.
• Assists in preparing provider contracts, amendments, and communications.
• Keeps informed on regulatory mandates to ensure compliance.
• Responds to inquiries from providers and colleagues and leads issue resolution.
• Maintains privacy and adheres to corporate policies.

Skills

Provider reimbursement

Contract analysis

Financial modeling

Contract language

Healthcare industry trends

Communication skills

Education

Bachelor's degree in Health Care Administration

Job description

Capital District Physicians Health Plan Inc (CDPHP) is seeking a network contracts professional to support the development and maintenance of provider networks and to negotiate provider contracts in alignment with corporate strategy.

The role requires expertise in provider reimbursement analysis, pricing methodologies, and regulatory compliance, with collaboration across clinical, network, and operations leadership to drive program success.