Provider Contract Operations Specialist negotiating healthcare provider contracts and managing relationships in health insurance sector. Focusing on compliance and financial terms while ensuring member access.
Responsibilities
Analyze financial impact of contracts and terms
Maintain contracts and documentation within a tracking system
May assist with identifying and recruiting providers based on network composition and needs
Communicate contract terms, payment structures, reimbursement rates to providers internal and external members
Negotiate and maintain contracts with MSO or primary care providers to ensure our network meets regulatory and business requirements
Manage relationships with key providers to support member access, minimize disruption, and maintain competitive advantage
Ensure contract terms are implemented and that our organization is protected from risk, both financially and legally
Support cross-functional teams with updates on contracting status, rate changes, and network developments
Requirements
2 or more years of experience in negotiating or servicing HMO managed care contracts
Proficiency in Understanding of contract terms, payment structures and reimbursement rates
Experience with public speaking or presentation skills and with provider facing communication
Experience with Value-based Contracting
Proficiency in MS Office Word and Excel (IE pivot tables, formulas, v-look up)
Benefits
medical, dental and vision benefits
401(k) retirement savings plan
time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
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