Provider Contracts Specialist

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🔥 1 hour ago

🌾 North Dakota, Minnesota, +2 more states – Remote

🌾 North Dakota – Remote ❄️ Minnesota – Remote 🗿 South Dakota – Remote 🧀 Wisconsin – Remote

💵 $24 - $38 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Sanford Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1894

⚕️ Healthcare Insurance

Healthcare Insurance

Sanford Health is the largest rural health system in the United States, dedicated to transforming the healthcare experience and providing access to world-class healthcare in America's heartland. Headquartered in Sioux Falls, South Dakota, Sanford Health serves over 1. 4 million patients and nearly 200,000 health plan members across 250,000 square miles. The integrated health system includes 48 medical centers, 211 clinic locations, and more than 160 senior living centers, employing 2,900 physicians and advanced practice providers. Sanford Health is committed to offering compassionate care through its Centers of Excellence, focusing on specialties such as cancer, orthopedics, women’s health, and genetics. Additionally, it provides affordable health insurance, engages in extensive clinical trials, and supports personalized genetic medicine.

📋 Description

• Works directly with chain of command to develop and implement contracting strategy with various types of providers/facilities across the Health Plan service area. • Evaluates and negotiates physician, ancillary and hospital contracts, including contract language and reimbursement methodologies for fee for service arrangements. • Prepares standard accurate agreements to formalize such arrangements. • Ability to identify data needed to evaluate and develop network reimbursement proposals to develop arrangements advantageous to our members and Health Plan. • Calls upon team analysts for support. • Works directly with team analysts and other department managers to understand how the negotiated agreement is translated into the company's systems. • Prepares timely and accurate communications to other departments for loading finalized agreements into production. • Assists with internal audit of provider records to ensure accurate reimbursement. • Serve as liaison to other departments on contract and reimbursement interpretation issues and ensures timely turnaround. • Must have strong knowledge of the Health Plan's end-to-end provider engagement processes, including interdepartmental handoffs as well as plan policies and procedures to ensure the best possible provider experience. • Manage or participate in project work as assigned. • May be called upon to assist in network education, onboarding and overall network relationship building.

🎯 Requirements

• Bachelor’s degree or equivalent experience preferred in the areas of finance, business, health care administration, or communications • Prior experience working with health care insurance or insurance network management • 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

🏖️ Benefits

• Health insurance • 401(k) • Paid time off • Flexible work arrangements