Strategic Provider Network Contracting Analyst

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

Job summary

Capital District Physicians' Health Plan Inc is seeking a professional to join the network contracting and administration team in New York. You will develop and maintain provider networks, analyze reimbursement, and negotiate contracts in line with corporate strategy.

You will apply regulatory requirements, model financial scenarios, and present findings to internal and external stakeholders, coordinating with clinical and operational leadership to ensure network adequacy and compliant

Qualifications

• Six years of provider network reimbursement or related experience.
• Two years of provider contracting or reimbursement analysis experience.
• 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.
• Serves as provider network contracting and administration SME for assigned areas.
• Analyzes and proposes formal provider reimbursement recommendations within budgets and according to health plan strategies.
• Collects and interprets data and information to support contracting activities and applies regulatory requirements.
• Effectively prepares and presents information, findings, and recommendations to stakeholders.
• Coordinates provider network contract and administration work items with stakeholders; tracks progress.
• Engages in provider contract negotiations with providers, clinical, and operational leadership.
• Assists in preparation of provider contracts, amendments, and communications.
• Maintains knowledge of legislative and regulatory mandates for compliance.
• Responds to inquiries from providers and colleagues and leads issue resolution.
• Upholds Lifetime Healthcare Companies' mission, values and privacy policies.
• Maintains regular attendance; performs other duties as assigned.

Skills

Contract & reimbursement analysis

Financial modeling

Contract interpretation

Regulatory compliance knowledge

Data analysis

Communication skills

Problem solving

Education

Bachelor's degree in Health Care Administration or relevant field

Job description

Capital District Physicians' Health Plan Inc is seeking a professional to join the network contracting and administration team in New York. You will develop and maintain provider networks, analyze reimbursement, and negotiate contracts in line with corporate strategy.

You will apply regulatory requirements, model financial scenarios, and present findings to internal and external stakeholders, coordinating with clinical and operational leadership to ensure network adequacy and compliant