As
Provider Contracting Advisor, you'll serve as an important part of the Provider Contracting Team and report to the AVP, Provider Contracting. In this role, you'll assist in developing our strategic direction and manage the day-to-day contracting and network management activities for the local market.
Responsibilities - Manage complex fee-for-service and value-based contracting, reimbursements, and negotiations with hospitals and physician groups.
- Build and maintain strong provider relationships to support network growth and value-based business opportunities.
- Partner closely with matrix teams (e.g., Claims, Medical Management, Credentialing) to ensure aligned execution.
- Develop strategic network positions, identify value-based and risk-based opportunities, and contribute to alternative network initiatives and analytics.
- Meet unit cost goals while maintaining an adequate and competitive provider network.
- Design and manage initiatives to improve medical cost and quality, providing consultative guidance informed by clinical informatics.
- Prepare, review, and project the financial impact of complex contracts
- Draft and manage healthcare provider (HCP) agreements through effective cross-functional collaboration.
- Lead the resolution of issues and manage key provider relationships, demonstrating deep knowledge of the local market landscape, including contract implementation and maintenance.
- Research problems and negotiate with partners and customers to resolve complex and escalated issues
- Support less experienced staff as needed.
Qualifications- 3+ years of managed care contracting and negotiating experience involving complex delivery systems and organizations
- Strong provider relationship management skills, with demonstrated success building long-term external partnerships
- Knowledge of complex reimbursement methodologies, including incentive-based models (strongly preferred)
- Deep understanding of hospital, managed care, and provider business models
- Strong presentation and communication skills, including the ability to build internal relationships in a fast-paced, matrixed organization
- Customer-centric approach with strong interpersonal skills and comfort navigating change
- Strong problem-solving, decision-making, negotiation, contract interpretation, and financial analysis skills
- Proficiency in Microsoft Office
Preferred Qualifications - Bachelor's degree in a related field (industry experience may substitute)
- MBA or MHA
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
