Provider Contracting Strategist

Quartz is seeking a healthcare reimbursement expert to join our organization in a critical role that bridges health plan and provider reimbursement strategies. This position is ideal for a subject-matter expert who can influence enterprise-wide decisions using a financial, data-driven approach.

About the role

Work in a collaborative, provider-aligned environment, serving as a liaison focused on building strong partnerships and long-term value for health plan and provider stakeholders. Serve as a strategic advisor, influencing contracting decisions that directly impact financial outcomes and patient care.

Responsibilities

• Evaluate and assess provider network contracts for new and existing provider agreements, ensuring mutually beneficial terms that are aligned with current national and local competitive landscape and practices.
• Identify outliers and opportunities for improvement in new and existing provider agreements.
• Perform financial analysis, fee schedule generation, and analytics in accordance with internal modeling and best practice.
• Assist with drafting, reviewing, and negotiating a wide range of provider contracts including value-based contracts and alternate payment methodologies.
• Assist in designing and refining provider networks based on clinical information, quality of care, and financial alignment.
• Advise internal stakeholders on contractual rights, obligations, risks, and opportunities, driving continuous improvement and ensuring alignment with company policies and compliance requirements.

Qualifications

• Bachelor’s degree with 2 years of experience with provider reimbursement methodologies, provider contractual terms, or related field using financial analysis, including construction of financial models and reports.
• Or Associate’s degree with 5 years of experience with provider reimbursement methodologies, provider contractual terms, or related field using financial analysis, including construction of financial models and reports.
• Or High School equivalency with 8 years of experience with provider reimbursement methodologies, provider contractual terms, or related field using financial analysis, including construction of financial models and reports.
• Provider reimbursement expertise across a variety of providers, including academic medical centers, acute care hospitals, community hospitals, ambulatory surgery centers, and/or critical access hospitals.
• Thorough understanding of fully insured and commercial payment methodologies.
• Advanced analytical capabilities, with the ability to use tools such as Excel, Business Objects, etc. to deliver and support data-driven recommendations.
• Enterprise-level thinking: understanding cross-departmental needs and challenges, with the ability to influence decisions and problem solve toward a common goal.
• Intellectual curiosity to stay abreast of latest reimbursement methodologies and ability to understand whether they are appropriate for Quartz.

Preferred licenses: Certified Billing and Coding Specialist (CBCS), Certified Coding Specialist (CCS), Certified Professional Coder (CPC).

Benefits

Quartz offers an excellent benefit and compensation package, opportunity for career advancement, and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness, and Relationships.

Pay

Starting salary based upon skills and experience: $78,000 to $98,500 annually plus a robust total rewards package.