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Group 1001 · 4 days ago

Provider Contracting Specialist

Atlanta, GA

Full-time

Onsite

Mid Level

$100K/yr - $140K/yr

3+ years exp

Group 1001 is a consumer-centric, technology-driven family of insurance companies dedicated to delivering outstanding value and operational performance. The Provider Contracting Specialist role involves drafting, negotiating, and maintaining provider contracts for Medicare Advantage, ensuring compliance with regulatory requirements, and supporting provider relations to enhance network adequacy and satisfaction.

FinanceFinancial ServicesInsurance

Responsibilities

Draft, negotiate, and execute provider contracts and amendments for physicians, hospitals, and ancillary providers

Maintain a complete and accurate record of all executed agreements and associated rate schedules

Ensure contract terms comply with CMS, state, and organizational requirements, including credentialing, termination, and delegation standards

Support contract rate analysis, financial modeling, and payment term reviews in collaboration with Finance and Claims teams

Develop and negotiate complex contract arrangements including contracts with IPAs, CINs, large health systems, and value-based contracts

Assist in network expansion to meet CMS network adequacy standards by identifying and recruiting targeted specialties and geographic areas

Maintain and update provider demographic data and contract details within network management systems

Coordinate closely with Credentialing, Provider Data Management, and Provider Relations to ensure seamless provider onboarding

Support regulatory audits, pre-delegation assessments, and ongoing oversight activities

Track contract renewals, expirations, and performance guarantees

Ensure all provider contracts align with current CMS guidance, state regulations, and Clear Spring Health policies

Partner with internal stakeholders to address escalations related to provider payment, network participation, and directory accuracy

Qualification

Provider contractingNetwork managementCMS complianceContract negotiationFinancial modelingMicrosoft ExcelAttention to detailOrganizational skillsCommunication skillsRelationship-building

Required

Bachelor's degree in Business Administration, Healthcare Management, or related field required

Minimum 3–5 years of experience in provider contracting, network management, or managed care operations

Strong understanding of CMS MA network adequacy, contracting, and compliance requirements

Proficiency in Microsoft Excel, Word, and contract management systems

Exceptional attention to detail, organizational skills, and ability to manage multiple priorities in a fast-paced environment

Strong communication, negotiation, and relationship-building skills

Preferred

Medicare Advantage experience preferred

Benefits

Comprehensive health, dental, and vision insurance plan options

Basic and Supplemental Life Insurance

Short and Long-Term Disability

Employee Assistance Program

Wellness programs

401K plan, with matching contributions by the Company

Company

Group 1001

Group 1001 is a collective that empowers companies to create positive growth. Our insurance and annuities are easy to understand and accessible to all.

Founded in 2013

Zionsville, Indiana, USA

1001-5000 employees