Senior Provider Contracting Specialist

Are you a skilled negotiator with a deep understanding of provider contracts and passion for problem solving? Priority Health is seeking a Senior Provider Contract Specialist to take ownership of affiliated network contracting. In this high-impact role, you will be the key contact and subject matter expert for all contract related activities - leading negotiations, managing contract lifestyles, and ensuring compliance while collaborating with stakeholders to drive strategic outcomes. With minimal direction, you will be the subject matter expert and answer questions, proactively resolve challenges, mitigate risks and contribute to continuous improvement in contract management. If you thrive in a fast- paced environment, hold yourself accountable, and enjoy navigating complex agreements, we invite you to join our team and make a meaningful impact in healthcare operations!

Job Summary

With minimal direction, acts as the key contact and subject matter expert for all contract-related activities. This includes developing and negotiating contract terms, conditions, modifications, penalties and incentives, while working with key stakeholders to ensure that their requirements are met. Analyzes and evaluates change to drive continuous improvement in the process of contract management and contract management trends. Leads the proactive, methodical management of contracts from initiation through execution, compliance and renewal. Provides support for management of medical cost of care and efficiency initiatives. Additionally, this position manages the contract execution process, resolving problems, mitigating delays, mediating disputes and escalating issues. Staff members in this position are effective and self-sufficient in working within a diverse selection of contracts and providers. Regularly provides guidance and training to less experienced Specialists.

Essential Functions

• Manages the contract development and negotiations process for provider networks initiatives. Enters/maintains current information in the internal contract repository and system contract database.

• Create and executive network development plans and deploy strategies to move providers to desired contract terms according to guidelines and standards. Provide effective oversight of contract implementation process ensuring all contracts are within required guidelines and financial parameters.

• Act as the principal contract negotiator for all assigned contracts. Manages contract review meetings to ensure delivery against objectives and contract budgets; develops regular reports on contract milestones and performance; and informs internal customers of activities and progress, through both verbal and written communications.

• Interface routinely with hospital, PHO, and PO leadership on an independent basis while understanding other political sensitivities of assigned groups.

• Work with and involve relevant stakeholders (internal customers) as needed in negotiation decisions impacting legal or regulatory requirements, contract standards, cost target and payment and pricing methodologies. Facilitate contract implementation process with the PIM team, including payment rates, PFP/PHO groupings, risk poll assignment, administration and other fees. Work collaboratively with PIM and other internal staff to find solutions to provider issues concerning payment and operation procedures, etc, when necessary.

• Creates a customer-focused, service-based approach to working with stakeholders which emphasizes the creation and cultivation of cross-organizational relationships.

• May represent contracting at external and Joint Operating Committee meetings. May oversee development and implementation of network expansion and individual physician recruitment within an assigned geographic area. May be requested to present and represent Provider Network Contracting at meeting with external constituencies.

• Provides mentoring to less experienced team members and is accountable as a role model for customer service excellence.

Qualifications

Required

• Bachelor's Degree or equivalent in business administration, health care administration, psychology, finance, health and human services

• 5 years of relevant experience negotiating and managing contract lifecycles on behalf of either third party payers or health care providers

• 7 years of proven experience leading negotiations directly and independently or leading a provider contracting team in negotiations

• Experience in finance or contract management and knowledge of CMS and commercial pricing practices and methodologies

Preferred

• Master's Degree in business administration, health care a