Senior Provider Contracting Professional
Core
Initiates, negotiates, and executes physician, hospital, and provider contracts for a health insurance organization to support network strategy, affordability, and member access.
Role type
Senior IC provider contracting professional
Builds
Enterprise provider network agreements and value-based arrangements
Domain
Health insurance / Managed care contracting
Required skills
Contract negotiation, network management, financial impact analysis, regulatory compliance, stakeholder management, MS Office
Preferred skills
ACO/Risk contracting, Value Based contracting, Master's Degree
Responsibilities
Lead provider contracting activity for assigned markets; Negotiate and execute provider agreements, amendments, renewals, and terminations; Resolve complex provider issues related to contract interpretation and escalations; Evaluate financial and operational impacts of proposed contract terms and reimbursement models; Ensure contract terms comply with policies and regulations; Collaborate with legal, finance, and clinical teams.
Seniority
Senior, hands-on IC