Network Management & Contract Analyst
About The Position
As a professional within the network contracting and administration team, the Network Management & Contract Analyst contributes to the development and maintenance of provider networks. The position performs provider and network analysis, evaluates provider reimbursement, and negotiates provider contracts in accordance with corporate strategy. It requires an understanding of provider types, applicable legal and regulatory requirements, pricing methodologies, industry and regional provider impacts and trends, provider reimbursement and related programs, and product lines. The role establishes and maintains network adequacy for assigned provider types, regions, and/or lines of business, and serves as a subject matter expert in assigned areas. It develops reimbursement recommendations, analyzes issues and data, prepares findings for stakeholders, coordinates and tracks network contracting initiatives, participates in provider negotiations, and helps prepare contracts and related communications. The analyst also supports compliance, responds to provider and colleague inquiries, and leads issue resolution with stakeholders. The position requires regular and reliable attendance and adherence to corporate conduct, values, and privacy requirements. It may require travel across the Health Plan service region for meetings and/or training. Compensation is Grade E3, with a stated range of $62,400 to $106,929. Remote work may be considered on a case-by-case basis.
Requirements
- Six years of provider network reimbursement or related experience, or a bachelor’s degree in Health Care Administration or a relevant field.
- Two years of experience directly performing provider contracting or reimbursement analysis.
- Demonstrated experience with provider reimbursement methodologies.
- Ability to draft, interpret, and apply contractual language.
- Technical skills including modeling and financial analysis.
- Understanding of medical care delivery, industry trends, and regional market dynamics.
- Strong, persuasive, and effective verbal and written communication skills.
- Knowledge of health care products and services offered to members.
- Excellent problem-solving skills.
- Ability to sit and/or stand at a workstation while viewing a computer and using a keyboard, mouse, and/or phone for three or more hours at a time.
- Ability to travel across the Health Plan service region for meetings and/or training as needed.
Responsibilities
- Establish and maintain network adequacy for assigned provider types, regions, and/or lines of business, and serve as a subject matter expert for assigned areas.
- Analyze, develop, and propose formal provider reimbursement recommendations within approved budgets and in accordance with health plan strategies.
- Identify, investigate, and analyze issues; collect and interpret information to support provider network contracting and administration activities.
- Apply contract terms, regulatory and legal requirements, and other relevant information to produce accurate, actionable analysis.
- Prepare and present information, findings, and recommendations to internal and external stakeholders.
- Liaise with assigned stakeholders to identify and coordinate provider network contract and administration work items.
- Execute initiatives and track, forecast, and report progress using qualitative and quantitative measures.
- Participate in provider contract negotiations and work directly with providers, clinical leadership, and operational leadership.
- Assist with preparing provider contracts, amendments, and communications.
- Maintain knowledge of relevant legislative and regulatory mandates to support compliance.
- Respond to and resolve inquiries from providers and colleagues about provider network contracting and administration, and lead issue resolution with internal and external stakeholders.
- Support the Lifetime Healthcare Companies’ mission and values, follow the Corporate Code of Conduct, and uphold the Lifetime Way values and beliefs.
- Protect member privacy in accordance with corporate privacy policies and procedures.
- Maintain regular and reliable attendance and perform other functions as assigned by management.
Benefits
- Group health insurance may be included in the total rewards package.
- Dental insurance may be included in the total rewards package.
- Retirement plan may be included in the total rewards package.
- Wellness program may be included in the total rewards package.
- Paid time away from work may be included in the total rewards package.
- Paid holidays may be included in the total rewards package.
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What This Job Offers
Job Type
Full-time
