Provider Contract Specialist

This is a hybrid position that will require occasional onsite presence.

Are you a skilled negotiator with an understanding of contracts and passion for problem solving? Priority Health is seeking a Provider Contract Specialist to take ownership of provider contracts at assigned hospitals and physician organizations across Michigan. In this high-impact role, you will be the key contact and subject matter expert for all contract related activities - this could include but is not limited to 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 provider agreements, we invite you to join our team and make a meaningful impact in healthcare operations!

Job Summary

With some supervision, acts as the key contact and subject matter expert for assigned contract-related activities. This includes developing and negotiation 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. Additionally, this position manages the contract execution process; resolving problems, mitigating delays, mediating disputes and escalation issues. Specialists at this level are competent to work in most areas of contract area but may require guidance in others.

Essential Functions

• Contributes to the contract development and negotiation process for provider network initiatives. Enters/maintains current information in the internal contract repository and enters contracts and contract information in the system contract database.
• Provide effective oversight of contract implementation process ensuring all contracts are within required guidelines and financial parameters. Renegotiate contracts within specific provider types under predetermined payment parameters.
• Manages contract review process to ensure delivery against objectives and contractual budgets; develops regular reports on contract milestones and performance; and informs internal customers, suppliers and management of activities and progress, through both verbal and written communications. With manual supervision acts as the principle contract negotiator for all assigned contracts.
• May support management in codifying contract terms for more complex contracts. Identifies barriers and opportunities in contracting with ability to articulate these obstacles to management for support as needed.
• Works with and involves relevant stakeholders (internal customers) as needed in negotiation decisions impacting legal or regulatory requirements, contract standards, cost targets and payment and pricing methodologies. Facilitate contract implementation processes with the PIM team including payment rates, PFP/PHO groupings, risk pool assignment, administration and other feels. Work collaboratively with PIM and others internal staff to find solutions to provider issues concerning payment and operating procedures with necessary.
• May be responsible for implementation of network expansion plans and individual physician recruitment within an assigned geographic area.
• Creates a customer-focused, service-based approach to working with stakeholders and suppliers, which emphasizes the creation and cultivation of cross-organizational relationship.
• May represent contracting and external meetings and Joint Operating Committee meetings. Interface routinely with physician practices managers and group administrators.

Qualifications

Required

• Bachelor's Degree or equivalent
• 2 years of relevant experience in a related field
• 5 years of relevant experience negotiating and managing contract lifecycles on behalf of either their part payer or health care providers

Preferred

• 5 years of relevant experience with the follow:
  • Knowledge of CMS and commercial pricing practices and methodologies
  • Knowledge of 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.

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 - Priority Health - 1239 E Beltline - Grand Rapids

Department Name

PH - Provider Network Contracting

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

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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.