Group 1001
Company Overview
Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer‑centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well‑being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina, and offers Medicare Prescription Drug Plans in 42 states plus DC. Why This Role Matters
The Provider Contracting Specialist supports the development, maintenance, and performance of Clear Spring Health’s Medicare Advantage provider network. This role is responsible for drafting, negotiating, and maintaining provider contracts, ensuring compliance with CMS and state regulatory requirements, and supporting provider relations to achieve high levels of provider satisfaction and network adequacy. The ideal candidate is detail‑oriented, collaborative, and driven by our mission to simplify health to enrich lives. How You’ll Contribute
Contracting & Negotiation
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. Network Development & Maintenance
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. Compliance & Performance
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. What We’re Looking For
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 (Medicare Advantage experience preferred). 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. Compensation
Base pay ranges from $100,000/year in our lowest geographic market up to $140,000/year in our highest geographic market, based on location and experience. Benefits Highlights
Employees who meet benefit eligibility guidelines and work 30 hours or more weekly are eligible to enroll in Group 1001’s benefits package, including comprehensive health, dental, vision, life insurance, disability, Employee Assistance Program, wellness programs, 401(k) with matching contributions, and more.
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Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer‑centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well‑being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina, and offers Medicare Prescription Drug Plans in 42 states plus DC. Why This Role Matters
The Provider Contracting Specialist supports the development, maintenance, and performance of Clear Spring Health’s Medicare Advantage provider network. This role is responsible for drafting, negotiating, and maintaining provider contracts, ensuring compliance with CMS and state regulatory requirements, and supporting provider relations to achieve high levels of provider satisfaction and network adequacy. The ideal candidate is detail‑oriented, collaborative, and driven by our mission to simplify health to enrich lives. How You’ll Contribute
Contracting & Negotiation
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. Network Development & Maintenance
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. Compliance & Performance
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. What We’re Looking For
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 (Medicare Advantage experience preferred). 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. Compensation
Base pay ranges from $100,000/year in our lowest geographic market up to $140,000/year in our highest geographic market, based on location and experience. Benefits Highlights
Employees who meet benefit eligibility guidelines and work 30 hours or more weekly are eligible to enroll in Group 1001’s benefits package, including comprehensive health, dental, vision, life insurance, disability, Employee Assistance Program, wellness programs, 401(k) with matching contributions, and more.
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