Provider Contract Management Specialist

About the role

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Responsibilities

• Prepares, configures, and maintains provider contract documents and templates in the contract management system, including technical coding, sub-coding, and system configuration to ensure accurate contract language, rates, and reporting capabilities.
• Conducts peer reviews and system testing of documents, templates, and configurations prior to production deployment to minimize contractual, administrative, and regulatory risks.
• Implements and coordinates provider contracts and reimbursement with Provider Operations, Provider Pricing, and Provider Enrollment staff, including annual fee schedule updates.
• Works cross-functionally with Network Management, Legal, and Regulatory Compliance teams to draft, coordinate, file, and revise provider contracts in compliance with state Insurance Commissioner requirements.
• Serves as the central point of contact for contract management system training, troubleshooting, and support, including developing training materials and conducting virtual sessions.
• Maintains the integrity and accuracy of the provider contract database and repository, conducting ongoing audits and communicating updates to Network Management and other divisions.
• Supports internal and external audits, triages claims and audit inquiries, processes Single Case Agreements, and assists with mass mailings across all Plans.
• Develops and maintains contract policies, procedures, and desk references, enforces business requirements and standards, and assists with stakeholder coordination on contract language, operational standards, and data governance.

Qualifications

• The Provider Contract Management Specialist would have a/an Bachelor's Degree in healthcare, business or related field and 3 years experience in the healthcare industry with a minimum of one year project-related experience, or equivalent combination of education and experience.
• Proficient in Microsoft Office and corporate software, with strong skills in grammar, formatting, and report preparation.
• Action-oriented with the ability to organize, prioritize, and meet deadlines while producing accurate, detail-focused work.
• Excellent oral and written communication skills for interfacing with internal and external contacts, including state regulatory bodies.
• Strong teamwork and collaboration skills with peers, leadership, and cross-functional teams.
• Proficient in contract management systems, including loading contract types, payment methodologies, document templates, and system reporting.
• Skilled in contract filing software to manage regulatory compliance and state filing requirements accurately.
• Familiarity with the Regence provider community, contracting protocols, reimbursement methodologies, and contract development processes desired.
• Experience with AI tools and technologies to enhance productivity and decision-making highly desired.

Skills and Attributes

• Proficient in Microsoft Office and corporate software, with strong skills in grammar, formatting, and report preparation.
• Action-oriented with the ability to organize, prioritize, and meet deadlines while producing accurate, detail-focused work.
• Excellent oral and written communication skills for interfacing with internal and external contacts, including state regulatory bodies.
• Strong teamwork and collaboration skills with peers, leadership, and cross-functional teams.
• Proficient in contract management systems, including loading contract types, payment methodologies, document templates, and system reporting.
• Skilled in contract filing software to manage regulatory compliance and state filing requirements accurately.
• Familiarity with the Regence provider community, contracting protocols, reimbursement methodologies, and contract development processes desired.
• Experience with AI tools and technologies to enhance productivity and decision-making highly desired.

Pay

• Oregon, Washington, Utah, and Idaho: The expected hiring range is$ 30.30 - $31.50, the full salary range is $28.40 - $46.30 and the bonus target is 10%.
• North Dakota: The expected hiring range is $29.00 - $31.00, the full salary range is $26.03 - $41.60.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.