Offer summary

Qualifications:

Bachelor’s degree in finance, business, health care administration, or communications preferred, or equivalent experience., Prior experience in health care insurance or network management is required., Strong skills in analyzing, communicating, and negotiating contract terms and reimbursement rates., Proficiency in MS Office applications and contract reading/redlining. .

Key responsibilities:

Maintain and coordinate pricing arrangements for provider groups and facilities in the Health Plan networks.

Create standard contracts for providers across the Health Plan service area.

Engage in provider recruitment activities to build and maintain compliant networks.

Occasionally travel for face-to-face meetings and conferences related to the role.

Job description

Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!

Job Title:

Provider Contract Specialist - Remote

Cost Center:

682891009 SHP-Administration

Scheduled Weekly Hours:

Employee Type:

Regular

Work Shift:

Mon-Fri; day shifts (United States of America)

Job Description:

JOB SUMMARY

Provider Contract Specialist (PCS) is responsible for maintaining, coordinating the process of, and establishing pricing arrangements involving provider groups, facilities and ancillary entities joining the Health Plan networks, including creating standard contracts for providers across the Health Plan service area. The PCS has an integral role in building and maintaining high value and compliant networks which may involve provider recruitment activities.

JOB QUALIFICATIONS

EDUCATION/EXPERIENCE

For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.

Preferred/Optional:

Bachelor’s degree is or the equivalent experience preferred in the areas of finance, business, health care administration or communications preferred but willing to waive with strong work experience.

Prior experience working with health care insurance or insurance network management, on commercial and/or government network reimbursement methodologies. Previous experience with behavioral health care reimbursement is a plus.

Experienced in analyzing, understanding, communicating, and negotiating financial impact of contract terms, payment structures and reimbursement rates with providers.

Proficiency with contract reading and redlining. Proficiency in MS Office applications.

Ability and willingness for occasional travel, including overnights, which may include holding face to face meetings at the Health Plan offices, provider offices or attending conferences.

Work at Home/Remote Requirements must ensure designated work area is free from distractions during work hours and virtual meetings, and must provide a high-speed DSL or cable modem for a workspace.

Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.

Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.

Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

Required profile