Healthcare Provider Network & Contract Management Specialist

Cobalt Benefits Group•Providence, RI

12d•Onsite

About The Position

The Healthcare Provider Network & Contract Management Specialist is responsible for maintaining, updating, and ensuring the integrity of healthcare provider and contract-related data within the health plan administration system. This role supports provider network management, client-specific healthcare contract implementation, reimbursement validation, pricing configuration, network tiering, and contract testing activities. The ideal candidate is detail-oriented, analytical, and collaborative, with the ability to work effectively across operational teams, clients, and external partners to ensure accurate implementation and maintenance of provider network and contract configurations.

Requirements

Associate degree or equivalent combination of education and experience.
Three or more years of related experience preferred.
Working knowledge of Microsoft Office applications, including Outlook, Excel, and Word.
Experience with provider contracts, provider network maintenance, reimbursement validation, contract configuration, or healthcare network tiering preferred.
Experience working with 835 and 837 electronic claim files preferred.
Strong customer service skills with a commitment to supporting internal and external stakeholders.
Excellent organizational, analytical, and problem-solving skills.
Ability to prioritize work, manage multiple assignments, and work independently in a fast-paced environment.
Strong written and verbal communication skills.

Responsibilities

Implement, configure, and maintain client-specific provider contracts, reimbursement methodologies, pricing arrangements, and related system records.
Validate contract configuration against approved client requirements, source documentation, fee schedules, and reimbursement methodologies.
Develop, document, and execute contract testing scenarios to ensure accurate pricing, reimbursement, and claims processing outcomes prior to implementation or production updates.
Coordinate contract implementation and maintenance activities with internal departments, network partners, clients, and other stakeholders.
Maintain organized and accurate documentation related to provider networks, contracts, pricing arrangements, affiliations, tiering structures, and implementation decisions.
Support provider network tiering setup, validation, testing, and ongoing maintenance activities.
Monitor medical and dental network changes to ensure updates are implemented accurately, consistently, and in a timely manner.
Perform provider contract and pricing maintenance, including the identification and resolution of configuration discrepancies.
Import and analyze 835 and 837 electronic claim files to support contract validation, reimbursement analysis, and provider maintenance activities.
Respond to provider, network, and contract-related requests within established service standards.
Support audits, quality reviews, issue resolution, and continuous improvement initiatives related to provider data, contract configuration, network maintenance, and reimbursement accuracy.

Benefits

Fantastic medical, dental, and vision insurance
Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
Company provided Basic Life and AD&D
Company paid Short-Term and Long-Term Disability
Flexible Spending Accounts
401(k) Retirement Plan with up to a 6% employer-match WOW! (100% fully vested after 3 years)
10+ paid holidays
Fully Paid half day Summer Fridays
Generous paid vacation and sick time
Annual Paid Volunteer Day
Annual Tuition Reimbursement
Annual Health and Wellness Reimbursement
Lots of fun company events