Job description
Job Summary
With some supervision, supports the contracting team in the contracting negotiation and execution process. Acts as the key contact for external contracting entities and internal departments, reviewing provider network deficiencies, resolving problems, mitigating implementation delays and escalating issues. Performs data analytics as needed to support the contract negotiation process. Performs data input into and extracts information from contracting warehouse software. Directly oversees physician contracting inquiries. Under supervision, may develop and negotiate contract terms, conditions, modifications, penalties and incentives, while working with key stakeholders to ensure that their requirements are met. Associates at this level will interact directly with the provider network, but may require guidance from Sr. Provider Contract Specialists.
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 and execution process ensuring all contracts are within required guidelines and financial parameters. May renegotiate contracts within specific provider types under predetermined payment parameters.
Identifies barriers and opportunities in the contracting process with ability to articulate these obstacles to management for support as needed.
Works with and involves relevant stakeholders (internal and external customers) as needed. Facilitates contract implementation processes with the PIM team including fielding first level inquiries on payment rates, PFP/PHO groupings, risk pool assignment, administration and other fields. Works collaboratively with PIM and other internal staff to find solutions to provider issues concerning payment and operating procedures when necessary.
Working under the guidance of a Sr. Contract Specialist, will be responsible for individual physician recruitment within an assigned geographic area or network areas.
Creates a customer-focused, service-based approach to working with stakeholders and providers, which emphasizes the creation and cultivation of cross-organizational relationships.
Will routinely interface with physician practice managers, and PO/PHO credentialing staff to support the contracting process.
Qualifications
- Required Bachelor's Degree or equivalent
- 1 year of relevant experience Managed Care, Hospital or Health System Experience Required
2 years of relevant experience Managing Hospital or Payer Contracting lifecycle Preferred
1 year of relevant experience Data analysis; project management; financial analysis Preferred
6 months of relevant experience Knowledge of provider reimbursement methodologies Preferred
Physical Demands
Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
Waist to Waist > 5 lbs: Seldom up to 10 lbs
Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
Waist to Overhead > 5 lbs: Seldom up to 10 lbs
Bilateral Carry > 5 lbs: Seldom up to 10 lbs
Unilateral Carry > 5 lbs: Seldom up to 10 lbs
Pushing Force > 5 lbs: Seldom up to 10 lbs
Pulling Force > 5 lbs: Seldom up to 10 lbs
Sitting: Frequently
Standing: Occasionally
Walking: Occasionally
Forward Bend - Standing: Seldom
Forward Bend - Sitting: Occasionally
Trunk Rotation - Standing: Seldom
Trunk Rotation - Sitting: Occasionally
Reach - Above Shoulder: Seldom
Reach - at Shoulder or Below: Seldom
Handling: Occasionally
Forceful Grip > 5 lbs: Seldom
Forceful Pinch > 2 lbs: Seldom
Finger/Hand Dexterity: Frequently
Primary Location
Department Name
PH - Provider Contracting
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8 a.m. to 5 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
CURRENT SPECTRUM HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Spectrum Health team members only.
Spectrum Health is committed to providing a safe environment for our team members, patients, visitors and community. That is why we require a drug-free workplace and various vaccinations as a requirement for employment.
Spectrum 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.
If you are a qualified individual with a disability, you may request assistance in completing the application process by calling 616.486.7447. We are committed to granting reasonable accommodations in accordance with applicable laws.
Spectrum 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.
If you are a qualified individual with a disability, you may request assistance in completing the application process by calling 616.486.7447. We are committed to granting reasonable accommodations in accordance with applicable laws.
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