Associate, National Provider Contracting
O
OscarHealth insurance
This is a remote position based in the field, open to candidates who reside: Alabama, Arizona, California, Florida, Illinois, Iowa, Kansas, Michigan, Mississippi, Missouri, Nebraska, New York, North Carolina, Ohio and Texas.Full-TimeMiddle
SalaryThe base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $96,876 - $127,149 per year. The base pay for this role in all other locations is: $87,188- $114,434 per year. You are also eligible for annual performance bonuses.
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Job Details
- Experience
- 3+ years of experience in provider contracting, provider network management, healthcare consulting, healthcare operations, or a related field; 2+ years supporting provider network strategy and negotiating provider agreements; 1+ years performing financial analysis for healthcare markets, provider contracts, or product lines; 1+ years working with large data sets.
- Required Skills
- Financial analysis
Requirements
- Have 3+ years of experience in provider contracting, provider network management, healthcare consulting, healthcare operations, or a related field.
- Have 2+ years of experience supporting provider network strategy and negotiating provider agreements.
- Demonstrate experience managing complex, multi-stakeholder contracting work from analysis and negotiation through implementation and ongoing performance management.
- Have experience building effective relationships with provider contracting and operational leaders.
- Be able to communicate recommendations to internal stakeholders.
- Have 1+ years of experience performing financial analysis for healthcare markets, provider contracts, or product lines and translating findings into negotiation or improvement opportunities.
- Have 1+ years of experience working with large data sets, such as claims, utilization, fee schedules, contract inventories, and provider rosters.
- Bachelor’s degree in business, healthcare administration, finance, economics, or a related field, or equivalent professional experience is a bonus.
- Experience contracting with national ancillary provider organizations, multi-state provider groups, or large health systems is a bonus.
- Working knowledge of provider reimbursement methodologies, contract language, claims data, network adequacy, and provider operations is a bonus.
Responsibilities
- Support national contracting strategies for large ancillary providers and health systems, aligned with network adequacy, access, quality, and cost objectives.
- Manage an assigned provider portfolio through prospecting, evaluation, negotiation, implementation, performance management, renewal, and termination.
- Prepare and negotiate provider agreements covering reimbursement, operations, data sharing, performance, and compliance terms.
- Coordinate contract implementation with Legal, Finance, Provider Operations, Claims, Credentialing, Configuration, Compliance, and Market teams.
- Build relationships with provider contracting and operational leaders, lead business reviews, resolve escalated issues, and coordinate corrective action plans.
- Analyze claims, utilization, reimbursement, provider roster, market, and competitive data to develop negotiation positions and identify improvement opportunities.
- Monitor network and provider performance for access, adequacy, quality, cost, and contractual compliance; escalate risks and support remediation.
- Maintain contracting pipeline, status, documentation, and provider data, and meet service-level agreements and performance metrics.
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