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 of experience supporting provider network strategy and negotiating provider agreements; 1+ years of experience performing financial analysis for healthcare markets, provider contracts, or product lines; 1+ years of experience working with large data sets.
- Required Skills
- Financial analysis
Requirements
- 3+ years of experience in provider contracting, provider network management, healthcare consulting, healthcare operations, or a related field.
- 2+ years of experience supporting provider network strategy and negotiating provider agreements.
- Demonstrated experience managing complex, multi-stakeholder contracting work from analysis and negotiation through implementation and ongoing performance management.
- Experience building effective relationships with provider contracting and operational leaders and communicating recommendations to internal stakeholders.
- 1+ years of experience performing financial analysis for healthcare markets, provider contracts, or product lines and translating findings into negotiation or improvement opportunities.
- 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.
- Experience contracting with national ancillary provider organizations, multi-state provider groups, or large health systems.
- Working knowledge of provider reimbursement methodologies, contract language, claims data, network adequacy, and provider operations.
Responsibilities
- Support the development and execution of national contracting strategies for large ancillary providers and/or health systems.
- Manage an assigned provider portfolio across prospecting, evaluation, negotiation, implementation, performance management, renewal, and termination.
- Prepare for and negotiate provider agreements covering reimbursement, operational, data-sharing, performance, and compliance terms.
- Coordinate contract implementation with Legal, Finance, Provider Operations, Claims, Credentialing, Configuration, Compliance, and Market teams.
- Build and maintain relationships with provider contracting and operational leaders; lead business reviews and resolve escalated issues.
- Analyze claims, utilization, reimbursement, provider roster, market, and competitive data to inform negotiations and identify improvement opportunities.
- Monitor networks 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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