Senior Provider Contracting Specialist

This is a hybrid position that requires working onsite 2 days per week.

Are you a skilled negotiator with a deep understanding of provider contracts and passion for problem solving Priority Health is seeking a Senior Provider Contract Specialist to take ownership of affiliated network this high-impact role you will be the key contact and subject matter expert for all contract related activities - leading negotiations managing contract lifestyles and ensuring compliance while collaborating with stakeholders to drive strategic outcomes. With minimal direction you will be the subject matter expert and answer questions proactively resolve challenges mitigate risks and contribute to continuous improvement in contract management. If you thrive in a fast- paced environment hold yourself accountable and enjoy navigating complex agreements we invite you to join our team and make a meaningful impact in healthcare operations!

Job Summary

With minimal direction acts as the key contact and subject matter expert for all contract-related activities. This includes developing and negotiating contract terms conditions modifications penalties and incentives while working with key stakeholders to ensure that their requirements are met. Analyzes and evaluates change to drive continuous improvement in the process of contract management and contract management trends. Leads the proactive methodical management of contracts from initiation through execution compliance and renewal. Provides support for management of medical cost of care and efficiency initiatives. Additionally this position manages the contract execution process resolving problems mitigating delays mediating disputes and escalating issues. Staff members in this position are effective and self-sufficient in working within a diverse selection of contracts and providers. Regularly provides guidance and training to less experienced Specialists.

Essential Functions

Manages the contract development and negotiations process for provider networks initiatives. Enters / maintains current information in the internal contract repository and system contract database.

Create and executive network development plans and deploy strategies to move providers to desired contract terms according to guidelines and standards. Provide effective oversight of contract implementation process ensuring all contracts are within required guidelines and financial parameters.

Act as the principal contract negotiator for all assigned contracts. Manages contract review meetings to ensure delivery against objectives and contract budgets; develops regular reports on contract milestones and performance; and informs internal customers of activities and progress through both verbal and written communications.

Interface routinely with hospital PHO and PO leadership on an independent basis while understanding other political sensitivities of assigned groups.

Work with and involve relevant stakeholders (internal customers) as needed in negotiation decisions impacting legal or regulatory requirements contract standards cost target and payment and pricing methodologies. Facilitate contract implementation process with the PIM team including payment rates PFP / PHO groupings risk poll assignment administration and other fees. Work collaboratively with PIM and other internal staff to find solutions to provider issues concerning payment and operation procedures etc when necessary.

Creates a customer-focused service-based approach to working with stakeholders which emphasizes the creation and cultivation of cross-organizational relationships.

May represent contracting at external and Joint Operating Committee meetings. May oversee development and implementation of network expansion and individual physician recruitment within an assigned geographic area. May be requested to present and represent Provider Network Contracting at meeting with external constituencies.

Provides mentoring to less experienced team members and is accountable as a role model for customer service excellence.

Qualifications

Required

Bachelors Degree or equivalent in business administration health care administration psychology finance health and human services

5 years of relevant experience negotiating and managing contract lifecycles on behalf of either third party payers or health care providers

7 years of proven experience leading negotiations directly and independently or leading a provider contracting team in negotiations

Experience in finance or contract management and knowledge of CMS and commercial pricing practices and methodologies

Preferred

Masters Degree in business administration health care administration finance health and human services

Experience working with legal staff

Skills in best practices for contract negotiation tactics and strategies

Working knowledge of anti-trust laws

About Corewell Health

As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement - to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

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How Corewell Health cares for you

Comprehensive benefits package to meet your financial health and work / life balance goals. Learn more here.

On-demand pay program powered by Payactiv

Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!

Optional identity theft protection home and auto insurance pet insurance

Traditional and Roth retirement options with service contribution and match savings

Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Corewell Health Southfield Center - 26901 Beaumont Blvd

Department Name

PH - Provider Network

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 a.m. - 5 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N / A

CURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.

An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.

Required Experience :

Senior IC

Key Skills

Computer Hardware,Mac Os,Manufacturing & Controls,Root cause Analysis,Windows,Customer Support,Remote Access Software,Operating Systems,Encryption,Remedy,Chemistry,Cerner

Experience : years

Vacancy : 1