Network Management & Contract Analyst

Univera Healthcare•Rochester, NY

16d•$60,410 - $106,929

About The Position

Summary: As a professional within the network contracting and administration team, the incumbent will contribute to the development and maintenance of provider networks. This position is accountable for performing provider and network analysis, evaluating provider reimbursement, and negotiating provider contracts in accordance with corporate strategy. As such, the role requires a multifaceted understanding of provider types, applicable legal and regulatory requirements, pricing methodologies, industry and regional provider impacts & trends, provider reimbursement and related programs, and product lines. Essential Accountabilities: Establishes and maintains network adequacy for assigned provider types, regions and/or lines of business. Serves as provider network contracting and administration subject matter expert for assigned areas. Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies. Identifies, investigates, and analyzes issues and questions. Collects and interprets data and information to support provider network contracting and administration activities. Applies applicable contract terms, regulatory and legal requirements, and other information to produce accurate and actionable analysis. Effectively prepares and presents information, findings, and recommendations to internal and external stakeholders. Serves as liaison with assigned stakeholders to identify and coordinate provider network contract and administration work items. Executes initiatives; tracks, forecasts and reports on progress including qualitative and quantitative measures. Engages in provider contract negotiations. Works routinely and directly with providers, clinical, and operational leadership. Assist in the preparation of provider contracts, amendments, and communications. Maintains knowledge of relevant legislative and regulatory mandates to ensure compliance. Responds to and resolves inquiries from providers and colleagues related to provider network contracting and administration. Leads issue resolution with internal and external stakeholders. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management.

Requirements

Six (6) years of provider network reimbursement or related experience required. Or a Bachelor’s degree in Health Care Administration or relevant field.
Two (2) years of experience directly performing provider contracting or reimbursement analysis required.
Demonstrated experience of 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.

Responsibilities

Establishes and maintains network adequacy for assigned provider types, regions and/or lines of business.
Serves as provider network contracting and administration subject matter expert for assigned areas.
Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies.
Identifies, investigates, and analyzes issues and questions.
Collects and interprets data and information to support provider network contracting and administration activities.
Applies applicable contract terms, regulatory and legal requirements, and other information to produce accurate and actionable analysis.
Effectively prepares and presents information, findings, and recommendations to internal and external stakeholders.
Serves as liaison with assigned stakeholders to identify and coordinate provider network contract and administration work items.
Executes initiatives; tracks, forecasts and reports on progress including qualitative and quantitative measures.
Engages in provider contract negotiations.
Works routinely and directly with providers, clinical, and operational leadership.
Assist in the preparation of provider contracts, amendments, and communications.
Maintains knowledge of relevant legislative and regulatory mandates to ensure compliance.
Responds to and resolves inquiries from providers and colleagues related to provider network contracting and administration.
Leads issue resolution with internal and external stakeholders.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.