Provider Contracting Specialist

This position is located in Little Rock, AR and required to work in office.

Some travel required. 

ESSENTIAL FUNCTIONS/RESPONSIBILITIES:

· Identify, recruit, and develop relationships with physicians, physician groups, hospitals, clinics, ancillary providers, facilities, and other healthcare organizations.

· Conduct in-person and virtual meetings with providers to introduce and promote the organization’s network and contracting opportunities.

· Explain network participation requirements, products, reimbursement structures, contractual obligations, and provider responsibilities.

· Develop and maintain productive, professional relationships with existing and prospective network providers.

· Serve as a primary contracting contact and organizational representative for assigned providers and healthcare organizations.

· Identify opportunities to expand or strengthen the provider network based on geographic needs, specialty availability, provider access, member needs, and network strategy.

· Respond to provider questions and concerns regarding contracting, reimbursement, network participation, and contractual requirements.

· Represent the organization professionally at provider meetings, community events, healthcare conferences, and other industry functions.

  Provider Contract Negotiation

· Negotiate provider agreements, amendments, reimbursement arrangements, and other contractual terms within established organizational guidelines and authority.

· Evaluate provider proposals and develop negotiation strategies that balance competitive reimbursement with organizational financial objectives.

· Review provider contracts and reimbursement terms for accuracy, consistency, and compliance with organizational requirements.

· Collaborate with leadership, finance, claims, compliance, network operations, and other departments as needed during the contracting process.

· Prepare contracting recommendations and escalate complex or high-value negotiations for appropriate approval.

· Maintain accurate documentation of negotiations, provider communications, contract status, and final agreements.

· Monitor contract negotiations from initial discussion through execution and implementation.

  Single Case Agreements (SCA)

· Coordinate and negotiate Single Case Agreements for members requiring services from non-contracted providers or facilities.

· Work directly with providers, hospitals, facilities, and clinics to negotiate appropriate reimbursement and terms for individual cases.

· Evaluate proposed rates and negotiate reimbursement based on applicable benchmarks, contractual considerations, market conditions, and organizational guidelines.

· Ensure Single Case Agreements clearly define reimbursement, services covered, authorization requirements, effective dates, and other applicable terms.

· Coordinate with utilization management, claims, customer service, clinical operations, and other departments to ensure the SCA meets the needs of the member and organization.

· Track SCA negotiations through completion and ensure agreements are communicated to the appropriate operational teams.

· Identify recurring SCA activity that may indicate an opportunity for permanent network contracting.

Network Strategy & Analysis

· Evaluate provider network needs and identify gaps in geographic coverage, specialties, facilities, and access.

· Review provider utilization, reimbursement information, market trends, and other data to support contracting decisions.

· Recommend opportunities for provider recruitment and network expansion.

· Monitor competitor and market developments that may affect provider participation and reimbursement.

· Assist leadership with network development strategies and contracting initiatives.

· Maintain knowledge of healthcare reimbursement methodologies, provider market conditions, and applicable regulatory requirements.

  Contract Administration & Compliance

· Maintain accurate provider contracting records and ensure agreements are completed and executed according to established procedures.

· Coordinate with internal departments to ensure contracted terms are accurately loaded and implemented in applicable systems.

· Monitor contract expiration dates, amendments, renewals, and other required actions.

· Ensure provider agreements and Single Case Agreements comply with organizational policies, contractual requirements, and applicable federal and state regulations.

· Maintain confidentiality of provider, member, financial, and organizational information.

· Prepare reports and status updates regarding contracting activity, network development, negotiations, and outstanding agreements.

REQUIRED QUALIFICATIONS AND EDUCATION:

· Bachelor’s degree in business, healthcare administration, finance, or a related field preferred; equivalent healthcare industry experience may be considered.

· 3–5 years of experience in healthcare provider contracting, network management, managed care, health insurance, third-party administration, or a related healthcare field.

· Demonstrated experience negotiating provider contracts, reimbursement rates, or Single Case Agreements.

· Strong understanding of healthcare provider networks and reimbursement methodologies.

· Excellent verbal, written, presentation, and negotiation skills.

· Ability to establish and maintain effective relationships with physicians, hospitals, healthcare executives, and other provider representatives.

· Strong analytical and problem-solving abilities.

· Ability to independently manage multiple negotiations and contracting projects.

· Proficiency with Microsoft Office and the ability to work effectively with contract management and healthcare information systems.

· Ability and willingness to travel locally and regionally for provider meetings as needed.

PREFERRED QUALIFICATIONS

· Experience with commercial, Medicare Advantage, Medicaid, or self-funded health plans.

· Experience working for a health plan, Third-Party Administrator (TPA), provider network, or healthcare organization.

· Experience negotiating hospital and facility agreements.

· Knowledge of fee schedules, bundled payments, case rates, per diem arrangements, and other healthcare reimbursement methodologies.

· Experience using healthcare claims and utilization data to support contracting negotiations.

· Knowledge of applicable provider network, managed care, and healthcare regulatory requirements.

Core Competencies

Relationship Management – Builds trust and productive working relationships with providers and internal stakeholders.

Negotiation – Effectively negotiates contractual and reimbursement terms while protecting the organization’s financial and operational interests.

Communication – Clearly explains complex contractual, reimbursement, and network information to providers and internal stakeholders.

Business Acumen – Understands the financial and strategic impact of provider contracting decisions.

Problem Solving – Identifies creative solutions to contracting challenges and provider access issues.

Organization – Effectively manages multiple negotiations, deadlines, agreements, and provider relationships simultaneously.

Professionalism – Represents the organization positively and professionally in all provider interactions.

Success in This Role

Success in this position will be measured by the ability to:

· Build and maintain a strong, high-quality provider network.

· Successfully recruit providers in identified network gaps.

· Negotiate competitive and financially responsible reimbursement arrangements.

· Resolve Single Case Agreements efficiently and appropriately.

· Develop strong relationships with hospitals, physicians, facilities, and clinics.

· Identify opportunities to convert recurring Single Case Agreements into permanent network contracts.

· Complete contracts accurately and within established timelines.

· Support network adequacy, provider access, member satisfaction, and organizational financial objectives.