Provider Network Specialist III

Sutter Health•Emeryville, CA

3d•$97,032 - $167,398

About The Position

Is responsible for the contract management of provider network agreements and negotiation of contract Letter of Agreements (LOAs). The primary focus is to assure the availability of contracted primary care and specialty providers to meet the geographic demand of the managed care contracts and other risk contracts under design. Provides analytical support for budgeting and contracting. May assist in special projects as assigned.

Requirements

Bachelor’s degree in Business Administration, Healthcare Management, Finance, or a related field; equivalent experience may be accepted in lieu of the degree.
Five years of recent relevant experience.
Working knowledge of health care, especially managed care principles, provider and HMO relationships, and Medicare/Medi-Cal principles.
Problem-solving skills, including financial, business, and contract analysis.
Knowledge of health care contract and billing terminology, provisions, and reimbursement methodologies, including managed care risk contracting and workers’ compensation.
Ability to work in a fast-paced, complex health care setting.
Knowledge of PC hardware and software, including MS Office (Word, PowerPoint, and Excel), and operation of a fax machine, scanner, and copier.
Organizational skills and ability to balance numerous priorities with minimal supervision.
Ability to field questions and translate them into meaningful action and solutions.
Ability to independently assess and structure data from diverse sources.

Responsibilities

Manage provider network agreements.
Negotiate contract Letters of Agreement (LOAs).
Help ensure contracted primary care and specialty providers are available to meet the geographic demands of managed care contracts and other risk contracts under design.
Provide analytical support for budgeting and contracting.
Assist with special projects as assigned.