Network Management & Contract Analyst

Univera Healthcare • Rochester, NY

2d

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. The role requires understanding 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 position establishes and maintains network adequacy for assigned provider types, regions, and/or lines of business; serves as a subject matter expert for assigned areas; develops reimbursement recommendations; analyzes issues and data; and presents findings to internal and external stakeholders. It also coordinates network contract and administration work, participates in provider negotiations, assists with contracts and related communications, maintains compliance knowledge, and resolves inquiries and issues. Regular and reliable attendance is expected. The role may require travel across the Health Plan service region for meetings and training.

The stated compensation range is $62,400 to $106,929. Actual salary may vary based on factors including budget, experience, knowledge, skills, education, and internal equity. The total rewards package may also include group health and/or dental insurance, a retirement plan, a wellness program, paid time away from work, and paid holidays. Remote work may be possible 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 work sitting and/or standing 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 trainings as needed.

Responsibilities

• Establish and maintain network adequacy for assigned provider types, regions, and/or lines of business.
• Serve as the provider network contracting and administration 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 and questions; collect and interpret information supporting provider network contracting and administration activities.
• Apply contract terms, regulatory and legal requirements, and other 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 leaders, and operational leaders.
• Assist in preparing provider contracts, amendments, and communications.
• Maintain knowledge of relevant legislative and regulatory mandates to ensure compliance.
• Respond to and resolve provider and colleague inquiries related to provider network contracting and administration.
• Lead issue resolution with internal and external stakeholders.
• Support the Lifetime Healthcare Companies’ mission and values, adhere to the Corporate Code of Conduct, and lead according to Lifetime Way values and beliefs.
• Maintain regard for member privacy in accordance with corporate privacy policies and procedures.
• Maintain regular and reliable attendance.
• 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.
• Remote work may be possible on a case-by-case basis.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level