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Univera Healthcare · 1 month ago

Network Management & Contract Analyst

Buffalo, NY

Full-time, Contract

Hybrid

Mid, Senior Level

$60K/yr - $107K/yr

6+ years exp

Univera Healthcare is a provider of health care services, and they are seeking a Network Management & Contract Analyst to contribute to the development and maintenance of provider networks. The role involves analyzing provider reimbursement, negotiating contracts, and ensuring compliance with regulatory requirements.

Health CareInsuranceMedicalNon Profit

Comp. & Benefits

Responsibilities

Establishes and maintains network adequacy for assigned provider types, regions and/or lines of business. Serves as provider network contracting and administration subject matter expert for assigned areas

Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies

Identifies, investigates, and analyzes issues and questions. Collects and interprets data and information to support provider network contracting and administration activities. Applies applicable contract terms, regulatory and legal requirements, and other information to produce accurate and actionable analysis

Effectively prepares and presents information, findings, and recommendations to internal and external stakeholders

Serves as liaison with assigned stakeholders to identify and coordinate provider network contract and administration work items. Executes initiatives; tracks, forecasts and reports on progress including qualitative and quantitative measures

Engages in provider contract negotiations. Works routinely and directly with providers, clinical, and operational leadership

Assist in the preparation of provider contracts, amendments, and communications

Maintains knowledge of relevant legislative and regulatory mandates to ensure compliance

Responds to and resolves inquiries from providers and colleagues related to provider network contracting and administration. Leads issue resolution with internal and external stakeholders

Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs

Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures

Regular and reliable attendance is expected and required

Performs other functions as assigned by management

Qualification

Provider reimbursement analysisProvider contractingFinancial analysisContractual language interpretationHealth care products knowledgeIndustry trendsVerbal communicationWritten communicationProblem-solving

Required

Six (6) years of provider network reimbursement or related experience required. Or a Bachelor's degree in Health Care Administration or relevant field

Two (2) years of experience directly performing provider contracting or reimbursement analysis required

Demonstrated experience of provider reimbursement methodologies

Ability to draft, interpret and apply contractual language

Technical skills including modeling and financial analysis

Understanding of medical care delivery, industry trends, and regional market dynamics

Strong, persuasive, and effective verbal and written communication skills

Knowledge of health care products and services offered to members

Excellent problem-solving skills