Senior Provider Contract Negotiator
About The Position
The Senior Provider Contract Negotiator plays a key role in developing and managing a high-performing, cost-effective, and compliant provider network. This position is responsible for negotiating, executing, maintaining contracts and relationships, and overseeing complex contracts (i.e., Primary Care Physician (PCP), specialist, ancillary providers, hospitals), ensuring alignment with regulatory standards and organizational objectives. The Senior Administrator leads initiatives to expand the provider network, supports strategic growth in managed care, and contributes to financial performance goals. This role also involves mentoring junior staff, enhancing provider relationships, and driving efforts to secure new partnerships while maintaining strong collaboration with existing providers and clients.
Requirements
- Bachelor's degree in a related field with 4 years of relevant experience (i.e., provider contracting, contract interpretation, negotiation, client relations) or 5+ years of relevant experience in lieu of a degree.
- Experience with Medicaid, Medicare Advantage, or Commercial provider networks required.
- Proficiency with contract lifecycle management systems and provider databases required.
- Knowledge of provider reimbursement methodologies (e.g., fee-for-service, capitation, value-based models) required.
- Familiarity with healthcare regulatory requirements (e.g., CMS, DHCS, DMHC, NCQA) related to provider networks is required.
- Experience with reviewing and negotiating contract language to ensure compliance with standards and regulatory requirements is required.
Nice To Haves
- Healthcare experience in Maa managed care, or with a physician group, clinical-based organization, and/or in a hospital/facility setting preferred.
Responsibilities
- Negotiating, executing, maintaining contracts and relationships
- Overseeing complex contracts (i.e., Primary Care Physician (PCP), specialist, ancillary providers, hospitals)
- Ensuring alignment with regulatory standards and organizational objectives
- Leading initiatives to expand the provider network
- Supporting strategic growth in managed care
- Contributing to financial performance goals
- Mentoring junior staff
- Enhancing provider relationships
- Driving efforts to secure new partnerships
- Maintaining strong collaboration with existing providers and clients
Benefits
- Medical, Dental and Vision insurance
- 403(b) Retirement savings plans with employer matching contributions
- Flexible Spending Accounts
- Commuter Flexible Spending
- Career Advancement & Development opportunities
- Paid Time Off & Holidays
- Paid CME Days
- Malpractice insurance and tail coverage
- Tuition Reimbursement Program
- Corporate Employee Discounts
- Employee Referral Bonus Program
- Pet Care Insurance
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What This Job Offers
Job Type
Full-time
Career Level
Senior
