C2Q Health Solutions
JOB PURPOSE:
The Provider Contracting Specialist responsible for the development, negotiation, and management of contracts with providers. This Includes, but is not limited to IPA's, primary care practices, specialty practices, LHCSA agencies, FQHC's, ancillary providers, hospital systems and other provider groups. This role addresses provider-related questions regarding contract language, contract set-up, billing, payment methodology, and other processes.
This role maintains strong relationships with providers while optimizing reimbursement rates and ensuring provider compliance with service level agreement, regulatory and organizational standards. The Provider Contracting Specialist works closely with various key stakeholders, including business development, clinical, claims operations, compliance, and finance, to track and monitor provider performance and quality standards.
JOB RESPONSIBILITIES: Develop, negotiate, and manage contracts with IPA's, primary care practices, specialty practices, LHCSA agencies, FQHC's, ancillary providers, hospital systems and other provider groups. Track and monitor provider performance to ensure contracts meet the organization's objectives, including financial terms, compliance, and quality of care requirements. Track and manage contract terms and renewals to ensure timely execution. Administer the on-boarding of new providers through the SCA process, data enter and update provider contracting tracker (PORF) and Care Compass. Track and monitor each SCA to ensure the closing of the SCA through contract conversion or termination. Maintain accurate records of contract negotiations, amendments, and renewals in the contract management system. Collaborate with internal teams, including legal, compliance, and finance, to draft, review, and finalize provider contracts. Assess and analyze provider performance and market conditions to support negotiation strategies. Respond to provider inquiries and resolve contract-related issues in a timely and professional manner. Ensure compliance with all relevant federal and state regulations, as well as organizational policies and procedures. Assist in the development of provider networks by identifying new potential providers and building relationships. Monitor and report on key performance metrics related to provider contracting and network development. Provide training and guidance to internal teams regarding contracting processes and best practices. Performs job responsibilities according to organization's policies. Seeks clarification when needed. Assumes responsibility for assignments given, seeks supervision appropriately, and is accountable for work performance. Meets productivity guidelines. Maintains proper documentation (updated, timely, legible) related to patient care, whether paper or electronic. Maintains HIPAA standards and confidentiality of PHI. Other duties as assigned. Service Standards
Timely and Accurate Contract Negotiation
Ensure all provider contracts are negotiated, reviewed, and finalized within established timelines.
Compliance with Regulatory Requirements
Ensure that all provider contracts comply with relevant federal, state, and organizational regulations, including health plan regulations, reimbursement rules, and data protection standards.
Effective Communication
Communicate regularly with internal teams and external providers to ensure smooth contract execution and dispute resolution.
Contract Renewals and Amendments
Manage timely renewals, amendments, and extensions of contracts to avoid service interruptions and ensure continuous provider participation.
Data Management and Documentation
Maintain accurate, up-to-date records of all contracts, provider interactions, and changes to terms.
Dispute Resolution
Address and resolve any provider disputes regarding contract terms, payments, or services promptly and professionally.
Customer Service Focus
Provide excellent customer service to providers, addressing inquiries, concerns, and contract-related questions efficiently and professionally.
Continuous Professional Development
Stay updated on industry trends, regulatory changes, and best practices in provider contracting and healthcare management.
Schedule:
8:30AM - 5:30PM
Weekly Hours:
40
QUALIFICATIONS:
Education:
Bachelor's degree in Business Administration, Healthcare Management, Finance or related field preferred or equivalent combination of education and experience.
Experience:
1-2 years of experience in healthcare provider contracting, managed care, or a related role. Vendor/ provider contracting experience is strongly preferred. Working knowledge of Medicare and Medicaid is required. Health plan/managed care setting, preferred. Experience in administrative support roles that involve data entry, documentation, or working with data is required. Attention to detail, critical thinking, time management skills, a sense of urgency. Strong interpersonal and communication skills with the ability to work collaboratively across departments. Discretion with highly sensitive information, including credentialing files, sanction lists, claims, and remittance information. Attention to detail and ability to maintain accurate records. Excellent organizational and time-management skills. Knowledge of Healthcare regulations (i.e.- HIPAA, CMS, etc.) and a commitment to patient data privacy and security. Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint) and the ability to learn contract management software quickly. Physical Requirements
Individuals must be able to sustain specific physical requirements essential to the job. This includes, but is not limited to:
Standing
- duration of up to 6 hours a day Sitting/Stationary positions
- sedentary position for a duration of up to 6-8 hours a day for consecutive hours/periods. Lifting/Push/Pull
- up to 50 pounds of equipment, baggage, supplies, and other items used in the job scope using OSHA guidelines, etc. Bending/Squatting
- have to be able to safely bend or squat to perform the essential functions under the scope of the job. Stairs/Steps/Walking/Climbing
- must be able to maneuver stairs safely, climb up/down and walk to access work areas. Agility/Fine Motor Skills
- Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (i.e., typing, use of supplies, equipment, etc.) Sight/Visual Requirements
- must be able to read documentation, papers, orders, signs, etc., and accurately type/write documentation, etc. Audio Hearing and Motor Skills (language) Requirements
- must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, one must be able to speak comfortably and clearly with language and motor skills for customers to understand an individual. Cognitive Ability
- Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.
Disclaimer:
Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.
We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.
Salary Range (Min-Max): $67,000.00 - $77,000.00
The Provider Contracting Specialist responsible for the development, negotiation, and management of contracts with providers. This Includes, but is not limited to IPA's, primary care practices, specialty practices, LHCSA agencies, FQHC's, ancillary providers, hospital systems and other provider groups. This role addresses provider-related questions regarding contract language, contract set-up, billing, payment methodology, and other processes.
This role maintains strong relationships with providers while optimizing reimbursement rates and ensuring provider compliance with service level agreement, regulatory and organizational standards. The Provider Contracting Specialist works closely with various key stakeholders, including business development, clinical, claims operations, compliance, and finance, to track and monitor provider performance and quality standards.
JOB RESPONSIBILITIES: Develop, negotiate, and manage contracts with IPA's, primary care practices, specialty practices, LHCSA agencies, FQHC's, ancillary providers, hospital systems and other provider groups. Track and monitor provider performance to ensure contracts meet the organization's objectives, including financial terms, compliance, and quality of care requirements. Track and manage contract terms and renewals to ensure timely execution. Administer the on-boarding of new providers through the SCA process, data enter and update provider contracting tracker (PORF) and Care Compass. Track and monitor each SCA to ensure the closing of the SCA through contract conversion or termination. Maintain accurate records of contract negotiations, amendments, and renewals in the contract management system. Collaborate with internal teams, including legal, compliance, and finance, to draft, review, and finalize provider contracts. Assess and analyze provider performance and market conditions to support negotiation strategies. Respond to provider inquiries and resolve contract-related issues in a timely and professional manner. Ensure compliance with all relevant federal and state regulations, as well as organizational policies and procedures. Assist in the development of provider networks by identifying new potential providers and building relationships. Monitor and report on key performance metrics related to provider contracting and network development. Provide training and guidance to internal teams regarding contracting processes and best practices. Performs job responsibilities according to organization's policies. Seeks clarification when needed. Assumes responsibility for assignments given, seeks supervision appropriately, and is accountable for work performance. Meets productivity guidelines. Maintains proper documentation (updated, timely, legible) related to patient care, whether paper or electronic. Maintains HIPAA standards and confidentiality of PHI. Other duties as assigned. Service Standards
Timely and Accurate Contract Negotiation
Ensure all provider contracts are negotiated, reviewed, and finalized within established timelines.
Compliance with Regulatory Requirements
Ensure that all provider contracts comply with relevant federal, state, and organizational regulations, including health plan regulations, reimbursement rules, and data protection standards.
Effective Communication
Communicate regularly with internal teams and external providers to ensure smooth contract execution and dispute resolution.
Contract Renewals and Amendments
Manage timely renewals, amendments, and extensions of contracts to avoid service interruptions and ensure continuous provider participation.
Data Management and Documentation
Maintain accurate, up-to-date records of all contracts, provider interactions, and changes to terms.
Dispute Resolution
Address and resolve any provider disputes regarding contract terms, payments, or services promptly and professionally.
Customer Service Focus
Provide excellent customer service to providers, addressing inquiries, concerns, and contract-related questions efficiently and professionally.
Continuous Professional Development
Stay updated on industry trends, regulatory changes, and best practices in provider contracting and healthcare management.
Schedule:
8:30AM - 5:30PM
Weekly Hours:
40
QUALIFICATIONS:
Education:
Bachelor's degree in Business Administration, Healthcare Management, Finance or related field preferred or equivalent combination of education and experience.
Experience:
1-2 years of experience in healthcare provider contracting, managed care, or a related role. Vendor/ provider contracting experience is strongly preferred. Working knowledge of Medicare and Medicaid is required. Health plan/managed care setting, preferred. Experience in administrative support roles that involve data entry, documentation, or working with data is required. Attention to detail, critical thinking, time management skills, a sense of urgency. Strong interpersonal and communication skills with the ability to work collaboratively across departments. Discretion with highly sensitive information, including credentialing files, sanction lists, claims, and remittance information. Attention to detail and ability to maintain accurate records. Excellent organizational and time-management skills. Knowledge of Healthcare regulations (i.e.- HIPAA, CMS, etc.) and a commitment to patient data privacy and security. Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint) and the ability to learn contract management software quickly. Physical Requirements
Individuals must be able to sustain specific physical requirements essential to the job. This includes, but is not limited to:
Standing
- duration of up to 6 hours a day Sitting/Stationary positions
- sedentary position for a duration of up to 6-8 hours a day for consecutive hours/periods. Lifting/Push/Pull
- up to 50 pounds of equipment, baggage, supplies, and other items used in the job scope using OSHA guidelines, etc. Bending/Squatting
- have to be able to safely bend or squat to perform the essential functions under the scope of the job. Stairs/Steps/Walking/Climbing
- must be able to maneuver stairs safely, climb up/down and walk to access work areas. Agility/Fine Motor Skills
- Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (i.e., typing, use of supplies, equipment, etc.) Sight/Visual Requirements
- must be able to read documentation, papers, orders, signs, etc., and accurately type/write documentation, etc. Audio Hearing and Motor Skills (language) Requirements
- must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, one must be able to speak comfortably and clearly with language and motor skills for customers to understand an individual. Cognitive Ability
- Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.
Disclaimer:
Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.
We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.
Salary Range (Min-Max): $67,000.00 - $77,000.00