Anticipated End Date:2026-08-07
Position Title:Provider Contract Spec Manager - IN HCN
Job Description:Provider Contract Spec Manager - IN HCNLocation: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The
Provider Contract Spec Manager functions with the expertise in managing negotiated pricing loads. Responsible for coordinating the process for the most complex pricing arrangements involving facilities or large health systems, or high profile provider groups and/or physician groups tied to large hospital systems joining the network including creating standard contracts for providers as needed.
How you will make an impact:- Manage provider update files submitted by delegated provider entities and/or large groups/integrated delivery system.
- Prepare the information for timely and accurate submission to the Provider Data Management area.
- Ensure updates/changes for existing network providers are interpreted and loaded accurately.
- Ensure accurate and timely loading of professional and facility contracts across value based and fee for service agreements for provider solutions.
- Works directly with contracting directors and managers to understand what is negotiated and how the negotiated agreement is translated into the company's systems resulting in accurate and timely loading.
- Performs internal audit of provider record, ensuring accuracy against rosters.
- Serves as the go-to with matrix partners to resolve interpretation issues and ensure timely turnaround.
- Serve as local market expert supporting (and managing when necessary) the provider onboarding process and provider updates submitted by provider offices within defined market.
- Must possess critical thinking skills, have a proven strong eye for detail and a focus on quality.
Minimum Requirements:Requires a H.S. diploma or equivalent and a minimum of 5 years of experience with provider contracts, plan procedures, and policies; or any combination of education and experience, which would provide an equivalent background
Preferred Skills, Capabilities and Experiences:- Previous experience working with provider pricing and reimbursement preferred.
- Experience with provider contracts and system configuration preferred.
- Experience with healthcare claims operations.
- Experience using the following systems highly preferred: SPS, PI, Tableau, WGS, GBD FACETS, MS Excel
Job Level:Non-Management Exempt
Workshift:1st Shift (United States of America)
Job Family:PND > Network Contracting
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.
