Provider Contracts Specialist
Job Summary
The Provider Contract Specialist (PCS) is responsible for maintaining, coordinating, and establishing pricing arrangements involving provider groups, facilities, and ancillary entities joining the Health Plan networks. This includes creating standard contracts for providers across the Health Plan service area. The PCS plays an integral role in building and maintaining high-value and compliant networks, which may involve provider recruitment activities.
Qualifications
- Bachelor’s degree or equivalent experience preferred in finance, business, health care administration, or communications
- Prior experience working with health care insurance or insurance network management, on commercial and/or government network reimbursement methodologies
- Previous experience with behavioral health care reimbursement is a plus
- Experience in analyzing, understanding, communicating, and negotiating financial impact of contract terms, payment structures, and reimbursement rates with providers
- Proficiency with contract reading and redlining
- Proficiency in MS Office applications
- Ability and willingness for occasional travel, including overnights, which may include holding face-to-face meetings at the Health Plan offices, provider offices, or attending conferences
Benefits
Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time-off package to maintain a healthy home-work balance. For more information about Total Rewards, visit here.
Work at Home/Remote Requirements
A designated work area free from distractions during work hours and a high-speed DSL or cable modem for a workspace are required.
Company Information
Sanford is an Equal Opportunity Employer. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org. Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.