Johns Hopkins Health Plans · 1 month ago
Contracting Specialist III
United States
Contract
Remote
Senior Level
$33.90/hr - $55.98/hr
5+ years expJohns Hopkins Health Plans is a leader in provider-sponsored health plans, focused on improving healthcare delivery. The Contracting Specialist III will be responsible for maintaining provider networks, negotiating complex contracts, and ensuring compliance with reimbursement standards to support strategic initiatives.
Health CarePersonal HealthWellness
Responsibilities
Responsible for maintaining the development of provider networks that includes recruitment, negotiating complex contracts, contacting, and re-contracting of current provider network
The position is responsible for reviewing network adequacy and determining recruitment needs within all specialties, taking appropriate actions to recruit new providers to fill in gaps to meet accreditation standards and JHHP’s strategic initiatives, and negotiating within the financial parameters to gain maximum cost efficiency and support JHHP’s goals and strategic initiatives
As a Contract Specialist III, you will negotiate complex contracts including Value based Contracts, Cost Reduction Related Contracts, “Risk” agreements, etc
Works in conjunction with analytics and the Finance team to develop financial models analyzing Value Based Contracts shared savings, Capitation, bundled pricing, and other reimbursement methodologies
Negotiates complex managed care contracts securing optimal reimbursement and driving high Quality outcomes
Leads the implementation process to ensure all contracts are loaded into the provider maintenance Systems, reporting is implemented and contract is operational
Manages the post implementation Process of all assigned Complex Contracts
Manages and audits the loading and updates of pricing and reimbursement terms to ensure contract compliance and appropriate reimbursement
Actively works within Networks Management and is the JHHP Networks management representative to address any questions or concerns related to complex contracts
Engage and develop JHHP contractual relationships with a wide range of behavioral health providers including psychiatrists, therapist, residential treatment facilities, and outpatient clinics
Lead the implementation process to ensure all contracts are loaded into the provider maintenance Systems, reporting is implemented, and contract is operational
Manage the post implementation process of all assigned complex contracts including behavioral health providers and /or other specialized provider types
Manage and audit the loading and updates of pricing and reimbursement terms to ensure contract compliance and appropriate reimbursement
Actively work within Networks Management and is the JHHP Networks management representative to address any questions or concerns related to complex contracts
Qualification
Required
More than five years prior experience in Contracting/Network Development in healthcare delivery program or insurance setting, experience in developing various reimbursement standards
Experience should include: Provider contracting, negotiating complex fee schedules, knowledge of managed care concepts and billing information systems
Requires a strong ability to negotiate high dollar reimbursement, sound knowledge of successful selling, and negotiation techniques and an awareness of healthcare contracting terms
Ability to negotiate provider contract fee schedules and performance guarantees
Strong ability to develop unique alternative reimbursement standards that are cost efficient
Familiarity and knowledge of managed care concepts required
Understanding of Mental Health Parity and Addiction Equity Act (MHPAEA) and its implications on contracting
Knowledge of HIPAA, CMS guidelines, and state-specific Medicaid managed care requirements
Competence in analyzing claims, utilization trends, cost data, and competitive market rates to support contract terms
Ability to use data to develop pricing proposals and assess financial impacts of contracting decisions
Excellent interpersonal, written, and verbal communication skills
Preferred
Bachelor's degree in business management or healthcare administration or related discipline
Experience with alternative payment models (APMs), value-based contracting, and bundled payments in behavioral health
Skilled in network adequacy analysis and identifying strategic network expansion opportunities
Benefits
Medical, Dental, and Vision Insurance.
403B Savings Plan w/employer contribution.
Paid Time off & Paid holidays.
Employee and Dependent Tuition assistance benefits.
Health and wellness programs and MORE!
Company
Johns Hopkins Health Plans
Johns Hopkins Health Plans provides excellent service and is dedicated to the health, life, and future.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
James Holland
President and CEO
Recent News
Johns Hopkins Health Plans
2025-11-20
Johns Hopkins Health Plans
2025-11-19
2025-09-12
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