Provider Relations and Contracting Specialist

Avera Health Plans

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Pay Range:

The pay range for this position is listed below. Actual pay rate dependent upon experience.

$25.50 - $38.25

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

The Provider Relations and Contracting Specialist plays a vital role in developing maintaining and strengthening relationships with healthcare providers across our network. This position supports strategic contracting initiatives ensures network adequacy and serves as a liaison between the health plan and its providers. The Provider Relations and Contracting Specialist will provide direct support to local and regional providers resolving issues in real time provider education and fostering collaborative partnerships that support high-quality cost-effective care for our members.

What you will do

• Serve as the primary point of contact for assigned providers and health system partners to address issues related to claims payments credentialing and contract interpretation.
• Conduct regular on-site and virtual provider visits to build and maintain strong relationships provide education on plan policies and assess provider satisfaction.
• Identify trends in provider concerns and collaborate with internal teams to implement solutions that improve provider experience and operational efficiency.
• Facilitate provider onboarding orientation and ongoing engagement efforts.
• Represent the organization in provider forums joint operating committee meetings and other provider-facing events.
• Support the negotiation implementation and renewal of fee-for-service and value-based contracts.
• Maintain and monitor provider contract data ensuring accuracy and timely updates in internal systems.
• Collaborate cross-functionally with Claims Finance Legal and Compliance to implement contracts and resolve issues.
• Prepare reports on network performance provider utilization and contracting outcomes for leadership.
• Willingness and ability to travel for provider site visits.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others hear understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge skills and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions as long as the accommodations do not cause undue hardship to the employer.

Required Education License/Certification or Work Experience:

• Excellent interpersonal and communication skills with the ability to build trust and rapport with provider partners.
• Must be organized detail-oriented and able to manage multiple priorities in a fast-paced environment.

Preferred Education License/Certification or Work Experience:

• Bachelors in Business Healthcare Administration or a related field.
• Masters
• 1-3 years Experience in provider relations provider contracting or network management in a health plan or healthcare setting.
• Knowledge of healthcare delivery systems provider reimbursement models (FFS DRG APC capitation VBP) and regulatory requirements.

Expectations and Standards

• Commitment to the daily application of Averas mission vision core values and social principles to serve patients their families and our community.
• Promote Averas values of compassion hospitality and stewardship.
• Uphold Averas standards of Communication Attitude Responsiveness and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles laws regulations and standards associated with but not limited to CMS The Joint Commission DHHS and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.

• Free health insurance options for full-time single coverage on Avera High Deductible Health Plan

• Up to 5% employer matching contribution for retirement

• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability Veteran Status or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application please call 1- or send an email to .