Provider Contracting Specialist

This position is located in Little Rock, AR and requires working in the office full-time.

Some travel required.

ROLE AND RESPONSIBILITIES

The Provider Contracting Specialist is responsible for developing, negotiating, executing, and maintaining provider network contracts and single case agreements with physicians, hospitals, facilities, clinics, and other healthcare providers. This position serves as a key representative of the organization in the provider community and is responsible for building strong, professional relationships with providers while promoting the organization’s health plans, programs, and network opportunities.

The Provider Contracting Specialist will meet directly with providers and healthcare organizations to explain the organization’s products, network requirements, reimbursement methodologies, contracting opportunities, and value proposition. The position requires strong negotiation, communication, relationship-building, analytical, and organizational skills, along with a solid understanding of healthcare provider contracting and reimbursement.

ESSENTIAL FUNCTIONS/RESPONSIBILITIES:

• Identify, recruit, and develop relationships with physicians, physician groups, hospitals, clinics, ancillary providers, facilities, and other healthcare organizations.
• Conduct in-person and virtual meetings with providers to introduce and promote the organization’s network and contracting opportunities.
• Explain network participation requirements, products, reimbursement structures, contractual obligations, and provider responsibilities.
• Develop and maintain productive, professional relationships with existing and prospective network providers.
• Serve as a primary contracting contact and organizational representative for assigned providers and healthcare organizations.
• Identify opportunities to expand or strengthen the provider network based on geographic needs, specialty availability, provider access, member needs, and network strategy.
• Respond to provider questions and concerns regarding contracting, reimbursement, network participation, and contractual requirements.
• Represent the organization professionally at provider meetings, community events, healthcare conferences, and other industry functions.

Provider Contract Negotiation

• Negotiate provider agreements, amendments, reimbursement arrangements, and other contractual terms within established organizational guidelines and authority.
• Evaluate provider proposals and develop negotiation strategies that balance competitive reimbursement with organizational financial objectives.
• Review provider contracts and reimbursement terms for accuracy, consistency, and compliance with organizational requirements.
• Collaborate with leadership, finance, claims, compliance, network operations, and other departments as needed during the contracting process.
• Prepare contracting recommendations and escalate complex or high-value negotiations for appropriate approval.
• Maintain accurate documentation of negotiations, provider communications, contract status, and final agreements.
• Monitor contract negotiations from initial discussion through execution and implementation.

Single Case Agreements (SCA)

• Coordinate and negotiate Single Case Agreements for members requiring services from non-contracted providers or facilities.
• Work directly with providers, hospitals, facilities, and clinics to negotiate appropriate reimbursement and terms for individual cases.
• Evaluate proposed rates and negotiate reimbursement based on applicable benchmarks, contractual considerations, market conditions, and organizational guidelines.
• Ensure Single Case Agreements clearly define reimbursement, services covered, authorization requirements, effective dates, and other applicable terms.
• Coordinate with utilization management, claims, customer service, clinical operations, and other departments to ensure the SCA meets the needs of the member and organization.
• Track SCA negotiations through completion and ensure agreements are communicated to the appropriate operational teams.
• Identify recurring SCA activity that may indicate an opportunity for permanent network contracting.

Network Strategy & Analysis

• Evaluate provider network needs and identify gaps in geographic coverage, specialties, facilities, and access.
• Review provider utilization, reimbursement information, market trends, and other data to support contracting decisions.
• Recommend opportunities for provider recruitment and network expansion.
• Monitor competitor and market developments that may affect provider participation and reimbursement.
• Assist leadership with network development strategies and contracting initiatives.
• Maintain knowledge of healthcare reimbursement methodologies, provider market conditions, and applicable regulatory requirements.

Contract Administration & Compliance

• Maintain accurate provider contracting records and ensure agreements are completed and executed according to established procedures.
• Coordinate with internal departments to ensure contracted terms are accurately loaded and implemented in applicable systems.
• Monitor contract expiration dates, amendments, renewals, and other required actions.
• Ensure provider agreements and Single Case Agreements comply with organizational policies, contractual requirements, and applicable federal and state regulations.
• Maintain confidentiality of provider, member, financial, and organizational information.
• Prepare reports and status updates regarding contracting activity, network development, negotiations, and outstanding agreements.

REQUIRED QUALIFICATIONS AND EDUCATION

• Bachelor’s degree in business, healthcare administration, finance, or a related field preferred; equivalent healthcare industry experience may be considered.
• 3–5 years of experience in healthcare provider contracting, network management, managed care, health insurance, third-party administration, or a related healthcare field.
• Demonstrated experience negotiating provider contracts, reimbursement rates, or Single Case Agreements.
• Strong understanding of healthcare provider networks and reimbursement methodologies.
• Excellent verbal, written, presentation, and negotiation skills.
• Ability to establish and maintain effective relationships with physicians, hospitals, healthcare executives, and other provider representatives.
• Strong analytical and problem-solving abilities.
• Ability to independently manage multiple negotiations and contracting projects.
• Proficiency with Microsoft Office and the ability to work effectively with contract management and healthcare information systems.
• Ability and willingness to travel locally and regionally for provider meetings as needed.

PREFERRED QUALIFICATIONS

• Experience with commercial, Medicare Advantage, Medicaid, or self-funded health plans.
• Experience working for a health plan, Third-Party Administrator (TPA), provider network, or healthcare organization.
• Experience negotiating hospital and facility agreements.
• Knowledge of fee schedules, bundled payments, case rates, per diem arrangements, and other healthcare reimbursement methodologies.
• Experience using healthcare claims and utilization data to support contracting negotiations.
• Knowledge of applicable provider network, managed care, and healthcare regulatory requirements.

CORE COMPETENCIES

Relationship Management – Builds trust and productive working relationships with providers and internal stakeholders.

Negotiation – Effectively negotiates contractual and reimbursement terms while protecting the organization’s financial and operational interests.

Communication – Clearly explains complex contractual, reimbursement, and network information to providers and internal stakeholders.

Business Acumen – Understands the financial and strategic impact of provider contracting decisions.

Problem Solving – Identifies creative solutions to contracting challenges and provider access issues.

Organization – Effectively manages multiple negotiations, deadlines, agreements, and provider relationships simultaneously.

Professionalism – Represents the organization positively and professionally in all provider interactions.

SUCCESS IN THIS ROLE

Success in this position will be measured by the ability to:

• Build and maintain a strong, high-quality provider network.
• Successfully recruit providers in identified network gaps.
• Negotiate competitive and financially responsible reimbursement arrangements.
• Resolve Single Case Agreements efficiently and appropriately.
• Develop strong relationships with hospitals, physicians, facilities, and clinics.
• Identify opportunities to convert recurring Single Case Agreements into permanent network contracts.
• Complete contracts accurately and within established timelines.
• Support network adequacy, provider access, member satisfaction, and organizational financial objectives.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Education:

• Bachelor's (Preferred)

Experience:

• healthcare provider contracting: 3 years (Required)
• healthcare network management: 3 years (Required)

Work Location: In person

Salary : $40,463 - $55,709