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Priority Health · 2 weeks ago

Senior Provider Contracting Specialist

Southfield, MI

Full-time

Hybrid

Senior Level

7+ years exp

Priority Health is seeking a Senior Provider Contract Specialist to take ownership of affiliated network contracting. In this high-impact role, you will be the key contact and subject matter expert for all contract related activities, leading negotiations, managing contract lifecycles, and ensuring compliance while collaborating with stakeholders to drive strategic outcomes.

Health Care

Responsibilities

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

Qualification

Contract negotiationContract managementProvider contractingFinancial analysisCMS pricing knowledgeStakeholder collaborationLegal knowledgeMentoringProblem solvingCommunication skills