Network Contracting Associate
Job Summary
The Associate, Network Contracting & Services manages and negotiates contracts with healthcare providers to build a robust network in Florida. This remote role involves analyzing provider performance, optimizing costs, and ensuring regulatory compliance. The position also supports network growth, provider relations, and local network strategy execution.
Responsibilities
- Manage and negotiate contracts with healthcare providers
- Implement contracting strategies aligned with cost management objectives
- Perform financial analyses and evaluate provider performance
- Monitor networks for compliance and support provider relations
Required Skills
- 3+ years in healthcare client management or contracting
- 2+ years supporting network strategy and negotiating contracts
- 1+ years running financial analyses
- Experience organizing large datasets like claim files
Job Details
About the role: The Associate, Network Contracting & Services is responsible for managing contracts with key healthcare providers in Oscar's network (hospital/health systems and individual provider groups) to build and maintain a robust network in assigned market/region; while also ensuring access to quality care and optimizing costs by analyzing provider performance and negotiating reimbursement rates, often involving complex contract terms and compliance with regulatory guidelines. The Associate also supports network growth and recruiting efforts by engaging with prospective providers directly; assisting with resolution of provider issues; supporting cost- saving initiatives; executing the local network strategy; and ensuring providers across our service area have the information and support they need to provide best-in-class member care. You will report into the Senior Director, Network Contracting & Services.
Responsibilities:
- Implement contracting strategies under the direction of Network Director and/or Senior Manager and in partnership with Market Leaders that align with the company's overall network adequacy, development and cost management objectives.
- Manage and negotiate contracts with assigned healthcare providers, focusing on favorable terms and compliance with organizational standards and regulatory requirements.
- Supports comprehensive reviews and analyses of assigned provider contracts, identifying areas for improvement and optimization.
- Utilizes data and analytics of provider financial issues and competitor strategies to support informing negotiation and contracting decisions.
- Meet defined metrics and SLAs including but not limited to provider outreach and contract completion.
- Collaborate with the provider services team regarding the servicing, education and communication to our provider network.
- Monitor assigned networks to gauge compliance with standards, developing corrective action plans with network contracting and market leadership to remediate deficiencies.
- Compliance with all applicable laws and regulations
- Other duties as assigned
Requirements:
- 3+ years of experience in healthcare client management, healthcare consulting, or provider healthcare contracting, healthcare operations, or a related field
- 2+ years of experience supporting provider network strategy development and negotiating provider contracts
- 1+ years experience running financial analyses on a markets or product lines, and working cross-functionally to support driving improvement opportunities
- 1+ years experience navigating and organizing large data sets such as claim files and provider rosters
- Bonus points: Associate's degree or equivalent professional working experience.