Associate, National Provider Contracting
Core
Manage assigned portfolios of large national ancillary providers and multi-state health systems through the full contracting lifecycle, translating network access and affordability goals into executable strategies.
Role type
Senior IC provider contracting associate
Builds
Durable provider relationships and operationally sound, compliant contracts
Domain
Health insurance / Provider network management
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Provider contracting lifecycle management, complex multi-stakeholder negotiation, financial analysis of healthcare markets, claims and utilization data analysis, contract implementation coordination, performance monitoring and remediation
Preferred skills
Contracting with national ancillary providers or large health systems, knowledge of provider reimbursement methodologies and network adequacy
Technologies
Claims data, utilization data, fee schedules, contract inventories, provider rosters
Responsibilities
Manage assigned portfolio across prospecting, evaluation, negotiation, implementation, performance management, renewal, and termination. Prepare for and negotiate complex provider agreements including reimbursement and compliance terms. Coordinate contract implementation with Legal, Finance, Provider Operations, Claims, Credentialing, Configuration, Compliance, and Market teams. Build and maintain productive relationships with provider contracting and operational leaders; lead routine business reviews and resolve escalated issues. Analyze claims, utilization, reimbursement, provider roster, market, and competitive data to develop negotiation positions and quantify financial impact. Monitor assigned networks and provider performance for access, adequacy, quality, cost, and contractual compliance; escalate risks and support remediation. Maintain accurate contracting pipeline, status, documentation, and provider data; meet defined service-level agreements and performance metrics.
Seniority
Mid-level, hands-on IC
