Strategic Network Contracts & Reimbursement Analyst

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

Benefits offered by this job

Group health and/or dental insurance

Retirement plan

Wellness program

Paid time away from work

Paid holidays

Job summary

Univera Healthcare is seeking a professional within the network contracting and administration team to develop and maintain provider networks, analyze provider reimbursement, and negotiate contracts in line with corporate strategy.

The role requires understanding of provider types, regulatory requirements, pricing methodologies, and regional market dynamics, plus strong analytical and collaboration skills to work with internal and external stakeholders.

Qualifications

• Six (6) years of provider network reimbursement or related experience required, or a Bachelor’s degree in Health Care Administration or relevant field.
• Two (2) years of experience directly performing provider contracting or reimbursement analysis required.
• 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 and information to support provider network contracting and administration activities. Applies applicable contract terms, regulatory and legal requirements, and other information to produce accurate and actionable analysis.
• 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. Works routinely and directly with providers, clinical, and operational leadership.
• Assist in the preparation of provider contracts, amendments, and communications.
• Maintains knowledge of relevant legislative and regulatory mandates to ensure compliance.
• Responds to and resolves inquiries from providers and colleagues related to provider network contracting and administration. Leads issue resolution with internal and external stakeholders.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Skills

Provider network reimbursement

Contract negotiations

Financial analysis

Regulatory/compliance knowledge

Data interpretation

Effective communication

Education

Bachelor's degree in Health Care Administration or relevant field

Job description

Univera Healthcare is seeking a professional within the network contracting and administration team to develop and maintain provider networks, analyze provider reimbursement, and negotiate contracts in line with corporate strategy.

The role requires understanding of provider types, regulatory requirements, pricing methodologies, and regional market dynamics, plus strong analytical and collaboration skills to work with internal and external stakeholders.