Senior Network Contracting Specialist

Oscar Health•Remote, AZ

3h•$71,539 - $93,895•Remote

About The Position

Oscar is seeking a Senior Network Contracting Specialist to join their Network Contracting team. This role involves negotiating and managing contracts with healthcare providers to build a network in assigned markets, ensuring access to quality care, and improving costs through performance analysis and reimbursement rate negotiation. The position requires managing complex contract terms, adhering to regulatory guidelines, recruiting new providers, resolving provider issues, and supporting cost-saving initiatives. This is a remote position open to candidates in specific states, involving a mix of home office work and frequent travel for client meetings.

Requirements

2+ years of experience in provider network operations or contracting or provider services
1+ years of experience in Health Insurance (Individual or Medicare Advantage) or Healthcare industry
1+ years experience navigating and organizing large datasets such as claim files and provider rosters

Nice To Haves

Associate's degree or equivalent professional working experience.

Responsibilities

Support and direct involvement with negotiating contracts with assigned healthcare providers, focusing on favorable terms and compliance with organizational standards, strategy, and regulatory requirements.
Conduct comprehensive reviews and analyses of assigned provider contracts, identifying areas for improvement and optimization.
Uses data and analytics of provider financial issues and competitor strategies to inform negotiation and contracting decisions.
Support implementation of contracting policies and workflows; monitor and ensure effective and efficient contracting processes are in place.
Monitor and analyze important metrics for network performance, cost, and provider satisfaction, and provide reports to leadership for assigned provider accounts.
Ensure timely and professional resolution of provider issues
Build relationships with healthcare providers to ensure network stability and quality.
Help track and analyze goals to monitor provider satisfaction and operational efficiency.
Support provider onboarding, training, and resource distribution.
Collaborate with other teams such as Claims, Credentialing, and Contracting to resolve routine provider issues.
Participate in process improvement projects to improve workflows and enhance provider experience.
Compliance with all applicable laws and regulations (DO NOT REMOVE - REQUIRED)
Other duties as assigned (DO NOT REMOVE - REQUIRED)