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, evaluates reimbursement methodologies, partners with cross‑functional teams, communicates contract terms and financial impact to providers, maintains contract documentation, and assists in identifying and recruiting providers based on network needs.

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 with identifying and recruiting providers based on network composition and needs

Requirements

• 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
• Experienced in 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