Supplier Consultant, Medical Bill Review

Essential Duties & Responsibilities

• Collaborates with business partners to develop and execute supplier category strategies by identifying business requirements, providing market insights, and recommending sourcing approaches to support operational, financial, medical cost management, and business objectives.
• Develops and executes strategies to optimize medical cost containment programs including medical bill review, provider network utilization, fee schedule management, clinical review programs, and ancillary managed care services to achieve quality, financial, and customer outcomes.
• Sources, selects, negotiates, and contracts with suppliers, including developing RFPs, supplier evaluations, implementing sourcing strategies, and developing business cases for new or enhanced supplier solutions.
• Manages supplier relationships using the five pillars of supplier management: Performance, Contract, Finance, Risk, and Relationship.
• Maintains supplier performance by analyzing operational, financial, medical savings, network, service, and customer experience metrics to identify trends, risks, and improvement opportunities.
• Supports continuous improvement initiatives focused on supplier effectiveness, service quality, operational efficiency, cost management, and improved medical cost containment outcomes.
• Ensures supplier compliance with applicable state and federal regulations, contractual obligations, data privacy requirements, and industry standards related to medical bill review, managed care, provider network, and cost containment operations.
• Partners with business stakeholders and suppliers to investigate escalated issues, perform root cause analysis, develop corrective action plans, and drive issue resolution.
• Provides financial oversight including invoice validation, service credit monitoring, budget forecasting, spend analysis, savings validation, and tracking of supplier savings and performance commitments.
• May perform additional duties as assigned.

Skills, Knowledge & Abilities

• Strong knowledge of specialty area as well as solid knowledge of departmental sourcing practices and the commercial insurance industry with an in-depth expertise of managed care medical billing products and services.
• Good interpersonal skills and the ability to work independently and with personnel at all levels.
• Ability to prioritize and manage multiple tasks and projects.
• Knowledge of Microsoft Office Suite as well as other business-related software.
• Excellent negotiation, verbal and written communication skills.

Education & Experience

• Bachelor's degree or equivalent experience.
• Typically a minimum of five to eight years' work experience in supplier management.
• Experience managing healthcare, managed care, medical bill review, provider network, or cost containment vendors preferred.