Senior Hospital Contracting Strategist

About the role

The Senior Hospital Contracting Strategist / Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital and other provider contracts and agreements for a health insurance organization. Reporting to the Director, Provider Contracting, the role leads negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value‑based agreements.

Responsibilities

• Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value‑based agreements.
• Evaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangements.
• Partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable.
• Communicate contract terms, payment structures, and reimbursement rates to providers.
• Analyze financial impact of contracts and terms.
• Maintain contracts and documentation within a tracking system.
• Help identify and recruit providers based on network composition and needs.

Required Qualifications

• Bachelor’s degree.
• 5 or more years of hospital negotiation experience in Medicare.
• 5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company.
• Experience negotiating managed care contracts with hospital systems inclusive of post‑acute, ancillary providers and physicians.
• Ability to analyze, understand and communicate financial impact of contract terms, payment structures and reimbursement rates to providers.