Associate, National Provider Contracting

This is a fully remote position, open to applicants in Alabama, +14 more states.

📋 Description

• Assist in the formulation and implementation of national contracting strategies for significant ancillary providers and/or health systems, ensuring alignment with network adequacy, access, quality, and cost-management goals.

• Oversee a designated portfolio throughout the entire contracting lifecycle, including prospecting, assessment, negotiation, execution, performance oversight, renewal, and termination.

• Prepare for and negotiate intricate provider agreements, encompassing reimbursement, operational, data-sharing, performance, and compliance terms, adhering to established authority and escalation protocols.

• Facilitate contract implementation in collaboration with Legal, Finance, Provider Operations, Claims, Credentialing, Configuration, Compliance, and Market teams to guarantee precise and timely operational readiness.

• Cultivate and sustain productive relationships with provider contracting and operational leaders; conduct regular business reviews, address escalated issues, and coordinate corrective action strategies.

• Evaluate claims, utilization, reimbursement, provider roster, market, and competitive data to formulate negotiation strategies, assess financial impact, and pinpoint opportunities for performance enhancement.

• Monitor assigned networks and provider performance concerning access, adequacy, quality, cost, and contractual compliance; escalate risks and assist in remediation with Network and Market leadership.

• Maintain an accurate contracting pipeline, status, documentation, and provider data; adhere to defined service-level agreements and performance metrics for outreach, negotiations, and contract finalization.

• Adhere to all relevant laws and regulations.

• Carry out additional duties as assigned.

⛳️ Requirements

• Minimum of 3 years of experience in provider contracting, provider network management, healthcare consulting, healthcare operations, or a related field.

• At least 2 years of experience supporting provider network strategy and negotiating provider agreements.

• Proven experience managing complex, multi-stakeholder contracting processes from analysis and negotiation through to implementation and ongoing performance management.

• Experience in establishing effective relationships with provider contracting and operational leaders and articulating recommendations to internal stakeholders.

• A minimum of 1 year of experience conducting financial analysis for healthcare markets, provider contracts, or product lines and converting findings into negotiation or improvement opportunities.

• At least 1 year of experience working with large data sets, such as claims, utilization, fee schedules, contract inventories, and provider rosters.

• Bachelor’s degree in business, healthcare administration, finance, economics, or a related field, or equivalent professional experience. (Bonus points.)

• Experience in contracting with national ancillary provider organizations, multi-state provider groups, or large health systems. (Bonus points.)

• Familiarity with provider reimbursement methodologies, contract language, claims data, network adequacy, and provider operations. (Bonus points.)

🏝️ Benefits

• Employee benefits

• Unlimited vacation program

• Annual performance bonuses

• Medical benefits

• Dental benefits

• Vision benefits

• 11 paid holidays

• Paid sick time

• Paid parental leave

• 401(k) plan participation

• Life insurance

• Disability insurance

• Paid wellness time and reimbursements