Provider Contract Specialist
Provider Contract Specialist
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Salary Not Disclosed
1 Vacancy
Job Description
This is a hybrid position that will require occasional onsite presence.
Are you a skilled negotiator with an understanding of contracts and passion for problem solving Priority Health is seeking a Provider Contract Specialist to take ownership of provider contracts at assigned hospitals and physician organizations across Michigan. In this highimpact role you will be the key contact and subject matter expert for all contract related activities this could include but is not limited to 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 provider agreements we invite you to join our team and make a meaningful impact in healthcare operations!
Job Summary
With some supervision acts as the key contact and subject matter expert for assigned contractrelated activities. This includes developing and negotiation 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. Additionally this position manages the contract process; resolving problems mitigating delays mediating disputes and escalation issues. Specialists at this level are competent to work in most areas of contract area but may require guidance in others.
Essential Functions
- Contributes to the contract development and negotiation process for provider network initiatives. Enters/maintains current information in the internal contract repository and enters contracts and contract information in the system contract database.
- Provide effective oversight of contract implementation process ensuring all contracts are within required guidelines and financial parameters. Renegotiate contracts within specific provider types under predetermined payment parameters.
- Manages contract review process to ensure delivery against objectives and contractual budgets; develops regular reports on contract milestones and performance; and informs internal customers suppliers and management of activities and progress through both verbal and written communications. With manual supervision acts as the principle contract negotiator for all assigned contracts.
- May support management in codifying contract terms for more complex contracts. Identifies barriers and opportunities in contracting with ability to articulate these obstacles to management for support as needed.
- Works with and involves relevant stakeholders (internal customers) as needed in negotiation decisions impacting legal or regulatory requirements contract standards cost targets and payment and pricing methodologies. Facilitate contract implementation processes with the PIM team including payment rates PFP/PHO groupings risk pool assignment administration and other feels. Work collaboratively with PIM and others internal staff to find solutions to provider issues concerning payment and operating procedures with necessary.
- May be responsible for implementation of network expansion plans and individual physician recruitment within an assigned geographic area.
- Creates a customerfocused servicebased approach to working with stakeholders and suppliers which emphasizes the creation and cultivation of crossorganizational relationship.
- May represent contracting and external meetings and Joint Operating Committee meetings. Interface routinely with physician practices managers and group administrators.
Qualifications
Required
- Bachelors Degree or equivalent
- 2 years of relevant experience in a related field
- 5 years of relevant experience negotiating and managing contract lifecycles on behalf of either their part payer or health care providers
Preferred
- 5 years of relevant experience with the follow:
- Knowledge of CMS and commercial pricing practices and methodologies
- Knowledge of best practices for contract negotiation tactics and strategies
- Working knowledge of antitrust laws
About Corewell Health
As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our topnotch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
Ondemand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!
Optional identity theft protection home and auto insurance pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary Location
SITE Priority Health 1239 E Beltline Grand RapidsDepartment Name
PH Provider Network ContractingEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
8 a.m. 5 p.m.Days Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for NonCorewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drugfree workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an onsite or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.
An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
