Provider Network Specialist II

Organization:

SHSO-Population Health Services-Bay

Position Overview:

Provides contract management services for the provider network agreements. Negotiates contracts to assure the availability of contracted primary care and specialty providers to meet the geographic demand of the managed care contracts and other risk contracts under design. Ensures successful contract performance. Assists with the contracting process to develop and expand of our provider networks. Audits contract loading in systems to ensure proper administration of Managed Care lives. Provides analytical support for budgeting and contracting in addition to offering support and ongoing education to the provider network.

Job Description:

EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma.

• Bachelor's

TYPICAL EXPERIENCE:

• 2 years of recent experience.

SKILLS AND KNOWLEDGE:

• Extensive knowledge of health care contract and billing terminology, provisions and reimbursement methodologies including managed care risk contracting, workers’ compensation, and provider networks.
• Working knowledge of healthcare business, medical groups, and financing structures, including Federal and State regulations regarding multispecialty provider organizations and occupational health provides as set by Medi-Cal, Medicare, Workers’ Compensation, and other payors.
• General understanding of the structure of health maintenance organizations and preferred provider organizations.
• Business acumen and exceptional analytic skills, including advance project management competencies and financial/business/contract analysis experience.
• Possesses communication (written/verbal), interpersonal, and presentation skills to explain complex structures or sensitive information clearly and professionally to diverse audiences.
• Solid budget and finance skills, with the ability to negotiate effectively with staff, senior management, vendors, media partnerships, external agencies and organizations.
• Exceptional attention to detail with time management and organization skills, including the demonstrated ability to prioritize tasks, manage multiple projects simultaneously, and complete deliverables.
• General knowledge of computer applications, such as Microsoft Office Suite (Word, Excel and PowerPoint), Microsoft Access, and other software applications to support word processing, spreadsheet, and database functions.
• Work independently, as well as part of a multidisciplinary team, while demonstrating organization skills, including evaluating and adjusting work priorities to complete projects under tight deadlines.
• Develop and modify contracts under the general direction of the manager or director, provider network.
• Analyze possible solutions using precedents, existing departmental guidelines and policies, experience and good judgment to identify, evaluate, and solve standard problems.
• Work with diverse health and administrative professionals at all levels of the organization.
• Maintain strict confidentiality and ensure the privacy of each patient’s protected health information (phi).
• Build collaborative relationships with peers, employees, other departments, affiliates, and agencies to administer fair and compliant workers’ compensation claims.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Monday - Friday

Weekend Requirements:

As Needed

Benefits:

Yes

Unions:

No

This position is work from home eligible.

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $40.85 to $61.28 / hour. Colorado, Florida, Georgia, Illinois, Michigan, Nevada, North Carolina, Oregon, Pennsylvania, Texas Pay Range is $31.97 to $47.96 / hour. Arizona, Arkansas, Idaho, Louisiana, Missouri, Montana, South Carolina, Tennessee, Utah Pay Range is $28.42 to $42.63 / hour. Sacramento Valley CA Pay Range is $35.52 to $53.28 / hour.

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Qualified applicants with arrest and conviction records will be considered for employment. Applicants for specific positions are still required to disclose certain convictions during the application process, and those convictions may also be considered in determining eligibility for employment in accordance with applicable law.

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