Provider Relations Contracting and Network Specialist

SVCMC Inc•New York, NY

7h•$85,000 - $90,000•Hybrid

About The Position

The Provider Relations Contracting and Network Specialist initiates dialogue with prospective providers and ancillary providers based on business needs, helps providers understand plan policies and contractual requirements, and develops positive relationships with participating providers. The role analyzes business needs and maintains the provider network in compliance with those needs, collaborating with marketing and sales teams and family practice center staff. The specialist reviews, analyzes, negotiates, implements, and maintains contracts; identifies network development opportunities; supports provider applications, orientation, and training; and coordinates across departments to resolve complex provider issues. The position manages a territory that includes strategic network partnerships and the Plan’s family health centers. It also provides guidance on USFHP products, policies, procedures, and provider resources; responds to provider inquiries; tracks resolutions; monitors contract performance, quality, and regulatory compliance; and participates in annual HEDIS activities.

Requirements

At least 2 years of experience in a provider contracting role with existing marketing relationships.
3–5 years of experience working with providers, including medical groups, ancillary vendors, and allied health professionals.
Familiarity with reimbursement models such as DRG, fee-for-service, and bundled payments.
Proficiency in Microsoft Office (Word, Excel, PowerPoint, and Access).
Organized and detail-oriented.
Ability to meet stringent deadlines and adjust priorities and workload to business needs.
Excellent communication and analytical skills.
Experience with Salesforce.
Bachelor of Arts or Bachelor of Science degree required.

Nice To Haves

Experience with value-based contracting.
Familiarity with industry payment rules, billing, and coding.

Responsibilities

Review, analyze, negotiate, implement, and maintain contracts, including professional rate schedules and contractual language.
Identify network development opportunities through financial analysis, client requests, and product development.
Define performance improvement opportunities.
Assist with initial applications to ensure completeness, timeliness, and accuracy in accordance with established guidelines.
Assist with provider orientation and training.
Facilitate interdepartmental collaboration to resolve complex provider issues related to contracting and contract configuration.
Manage a territory, including strategic network partnerships and the Plan’s family health centers.
Provide general instruction and support on USFHP products, the provider manual, provider directory, Plan policies, and Plan procedures.
Research, resolve, and respond to provider and ancillary provider inquiries about participation and credentialing requirements and status, contract terms, fee schedules, reimbursement, utilization, access and availability standards, member eligibility, and consult report requirements.
Document and track inquiries and their resolution.
Monitor contract performance through site visits, claims, and data analysis.
Monitor quality and regulatory compliance and participate in annual HEDIS activities.
Assist with Provider Panel Report Cards and Scorecards.
Perform other duties as assigned by management.

Benefits

Medical coverage through UnitedHealthcare/Oxford with no deductible for in-network services.
Vision coverage through UnitedHealthcare Vision.
Dental benefits through MetLife.
Basic life and disability insurance provided at no cost.
Commuter benefits.
Tuition reimbursement.
401(k) retirement plan with an immediate employer match, fully vested from day one.
Vacation, 10 paid holidays, and 3 personal days.
Employee Assistance Program.
Exclusive discounts through Working Advantage.