SHP Provider Contract Consultant

JOB SUMMARY/PURPOSE

Responsible for the negotiation, development, implementation, and ongoing management of provider, hospital, and ancillary contracts across Medicaid, Medicare Advantage, and Commercial lines of business. Develops contracting strategies aligned with organizational financial, network adequacy, quality, and regulatory objectives. Leads complex negotiations, performs financial and reimbursement analysis, ensures regulatory compliance, and partners cross-functionally to support value-based payment initiatives and total cost of care management. Exercises independent judgment within established authority limits.

DEPARTMENT DESCRIPTION

Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage and Commercial Large Group plans. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

EXPERIENCE/EDUCATION/QUALIFICATIONS

• Bachelor’s degree in Business Administration, Healthcare Administration, Finance, or a related field, or equivalent related experience required.
• Three (3) years of progressive experience in provider contracting, network management, or managed care operations required.
• Experience negotiating hospital and/or professional agreements required.
• Experience in the following preferred:
• Medicaid, Medicare Advantage, and Commercial lines of business.
• Value-based payment models and risk-based contracting.
• Contract lifecycle management systems.
• Claims configuration and payment operations.
• Supporting network adequacy reporting.
• Delegation oversight and compliance auditing processes.

KNOWLEDGE/SKILLS/ABILITIES

• Strong understanding of CMS and state regulatory requirements. Knowledge of healthcare reimbursement methodologies (Medicare-based, DRG, OPPS, capitation, case rates, VBP).
• Knowledge of claims configuration and payment operations.
• Understanding of delegation oversight and compliance auditing processes.
• Strong financial modeling and analytical skills (advanced Excel proficiency).
• Ability to manage multiple negotiations simultaneously. Negotiation and conflict resolution expertise.
• Strong written and verbal communication skills. Ability to interpret complex legal and reimbursement language.
• Strategic thinking with strong business acumen.
• Ability to work independently with minimal supervision.

PHYSICAL DEMANDS

Rarely
(1 - 10% of the time)
Occasionally
(11 - 33% of the time)
Frequently
(34 - 66% of the time)
Continually
(67 – 100% of the time)