What are the responsibilities and job description for the Senior Provider Contract Specialist position at Priority Health?
Job Summary
Independently manages a portfolio of provider contracts and serves as an experienced Senior individual contributor for contract development, provider negotiations, implementation, compliance, and contract renewals. This role leads moderately to highly complex negotiations, evaluates financial and operational implications of contract terms, and partners with internal stakeholders to support our provider network, affordability, quality, and operational objectives. The Senior Provider Contractor applies strong judgment in managing provider relationships, resolving issues, and identifying opportunities for process improvement. This position is expected to work autonomously across a broad range of contract types and provider arrangements and provides guidance and training to less experienced contractors.
Essential Functions
Required
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids
Department Name
Provider Network Contracting - PH Managed Benefits
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 COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell 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.
You may request assistance in completing the application process by calling 616.486.7447.
Independently manages a portfolio of provider contracts and serves as an experienced Senior individual contributor for contract development, provider negotiations, implementation, compliance, and contract renewals. This role leads moderately to highly complex negotiations, evaluates financial and operational implications of contract terms, and partners with internal stakeholders to support our provider network, affordability, quality, and operational objectives. The Senior Provider Contractor applies strong judgment in managing provider relationships, resolving issues, and identifying opportunities for process improvement. This position is expected to work autonomously across a broad range of contract types and provider arrangements and provides guidance and training to less experienced contractors.
Essential Functions
- Manages the contract development and negotiation process for provider networks initiatives. Maintains accurate contract documentation in internal repositories and systems.
- Deploys negotiation approaches to move providers to desired contract terms according to guidelines and standards. Oversees contract implementation of their agreements to ensure operational accuracy and compliance with approved terms.
- Acts as the principal contract negotiator for all assigned contracts. Manages contract review meetings to ensure delivery against objectives and contract budgets; monitors progress against objectives, timelines, and financial targets; and communicates status, risks, updates, and recommendations to internal stakeholders through verbal and written updates.
- Interfaces with provider leadership on an independent basis while understanding other organizational dynamics and stakeholder sensitivities of assigned groups.
- Works with appropriate internal stakeholders on negotiation decisions impacting legal or regulatory requirements, contract standards, membership, cost targets, and reimbursement methodologies. Facilitates contract implementation process with the appropriate operational partners and works collaboratively with internal teams on any contract related matters.
- Creates a customer-focused, service-based approach to working with stakeholders, which emphasizes the creation and cultivation of cross-functional relationships that support collaboration and execution.
- Represents contracting at internal meetings. Leads external meetings with providers and actively manages the contract negotiations and the progress of any contract related initiatives. May support network expansion and provider recruitment activities.
- Provides mentoring to less experienced team members; and models strong customer service, contracting discipline, and professional judgement.
Required
- Bachelor's Degree or equivalent
- Bachelor's Degree in business administration, health care administration, psychology, finance, health and human services
- 5 years of relevant experience Negotiating and managing contract lifecycles on behalf of either third party payers or health care providers
- 5 years of relevant experience Proven experience leading negotiations directly and independently or leading a provider contracting team in negotiations.
- Experience in finance or contract management and knowledge of CMS and commercial pricing practices and methodologies
- Master's Degree
- Masters Degree in business administration, health care administration, finance, health and human services
- Experience working with legal staff Skills in best practices for contract negotiation tactics and strategies
- Working knowledge of anti-trust laws
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids
Department Name
Provider Network Contracting - PH Managed Benefits
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 COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell 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.
You may request assistance in completing the application process by calling 616.486.7447.