Provider Contract Specialist

Overview The Provider Contract Specialist is responsible for negotiating and managing provider agreements to ensure a high-quality, cost-effective, and market-competitive network. This role involves developing and maintaining provider relationships, ensuring compliance with regulatory standards, and supporting network adequacy. The Contract Specialist will also track contracts, generate reports, and contribute to strategic initiatives.

Responsibilities:

Provider Contract Negotiation & Management Initiate, negotiate, and finalize provider agreements, including Letters of Agreement (LOAs), contracts, and amendments, ensuring timely execution. Work with providers on various payment models, such as Fee-for-Service, Alternative Payment Methods, and Pay-for-Performance structures. Ensure accurate administration and documentation of provider contracts, including primary care, specialists, hospitals, ancillary services, and provider groups/IPAs. Network Development & Maintenance Support provider network expansion by researching, recruiting, and negotiating with healthcare providers. Maintain a Medicare-compliant network in assigned regions, focusing on physician and ancillary healthcare providers. Assist in evaluating network adequacy and implementing strategies to meet regulatory and organizational standards. Communication & Compliance Clearly communicate contract terms, reimbursement structures, and payment methodologies to providers. Ensure compliance with Medicare Advantage and Medicare Special Needs Plan (SNP) contracting requirements. Maintain up-to-date knowledge of healthcare regulations and compliance standards related to provider contracting. Data Management & Reporting Maintain accurate electronic records of contracts, amendments, renewals, and formal correspondence throughout the contract lifecycle. Analyze financial impacts of contracts and track key performance metrics. Participate in special projects related to provider contracting and network development. Collaboration & Strategic Initiatives Work closely with internal departments to improve contracting processes and provider relations. Provide recommendations for workflow enhancements and operational improvements. Must work on-site, but with willingness to travel within assigned regions as needed to support contracting initiatives.

Qualifications:

Required:

Associate's degree in a related field or equivalent experience. 2-4 years of experience in provider contract support, negotiation, or managed care. Experience in provider negotiating provider contracts, including physicians, hospitals, and ancillary providers. Understanding of contracting models and reimbursement structures.

Preferred:

1-3 years of managed care experience. Experience with Medicare Advantage and Special Needs Plans (I-SNP, C-SNP) preferred. Experience working with complex providers, specialist including Dialysis Centers.

Job Type:

Full-time Pay:

From $58,000.00 per year

Experience:

Managed care: 3 years (Preferred)

Contracting :

3 years (Preferred) Ability to

Commute:

Long Beach, CA 90815 (Required) Ability to

Relocate:

Long Beach, CA 90815: Relocate before starting work (Required)

Work Location:

In person