Senior Provider Contracts Specialist

Create Your Career With Us! Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States.
We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Facility: Fargo Health Plan Location: Fargo, ND Address: 1749 38th St S, Fargo, ND 58103, USA Shift: 8 Hours - Day Shifts Job Schedule: Full time Weekly Hours: 40.
00 Salary Range: $27.
50 - $44.
00 Department Details Great opportunity to step into a fast paced work environment, with lots of opportunity for professional development.
No two days are the same! Our department is a small but high functioning team that works very well together.
We are open to fully remote, hybrid, as well as full-time on site.
Job Summary The Senior Provider Contract Specialist (SPCS) is responsible for maintaining, coordinating the process of, and establishing more complex pricing arrangements involving high profile provider groups and large hospital systems joining the Health Plan networks, including creating standard contracts for providers across the Health Plan service area.
The SPCS has an integral role in building and maintaining high value and compliant networks which may involve provider recruitment activities.
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 both fee for service and value-based 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.
Serves as go-to to resolve 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.
Qualifications Bachelor s degree required 5 or more years prior experience working with health care insurance or insurance network management with a minimum of 3 years working with commercial and government network reimbursement methodologies.
Previous experience with behavioral health care reimbursement is a plus.
Proficiency 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.
Benefits Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees.
Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance.
For more information about Total Rewards, visit https://sanfordcareers.
com/benefits .
Sanford is an EEO/AA Employer M/F/Disability/Vet.
If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.
org .
Sanford Health has a Drug Free Workplace Policy.
An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0169537 Job Function: Legal and Compliance Featured: No