Network Management & Contract Analyst

Excellus BCBS • Rochester, NY

3d

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 of provider types, legal and regulatory requirements, pricing methodologies, industry and regional provider impacts and trends, provider reimbursement and related programs, and product lines.

The analyst establishes and maintains network adequacy for assigned provider types, regions, and/or lines of business and serves as a subject matter expert for assigned areas. The position works with providers, clinical and operational leadership, and internal and external stakeholders to coordinate contract and administration work, analyze issues, prepare recommendations, and resolve inquiries. Regular and reliable attendance is expected. Other functions may be assigned by management.

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 in 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.

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 data to support provider network contracting and administration activities.
• Apply contract terms, regulatory and legal requirements, and other information to produce accurate and actionable analysis.
• Prepare and present information, findings, and recommendations to internal and external stakeholders.
• Serve as liaison 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.
• Engage in provider contract negotiations and work routinely and directly with providers, clinical leadership, and operational leadership.
• 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 the Lifetime Way values and beliefs.
• Maintain regard for 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.

What This Job Offers

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