Network Contract Specialist

Company: Saint Alphonsus

General Information
Not Specified
Not Specified
Not Specified
Job Description Department:
ID601_70505 Saintalphonsus Health Alliance
Expected Weekly Hours:
Day Shift

Position Purpose:
At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.

Responsible for negotiating hospital, clinic and network managed care and direct payer contracts for Saint Alphonsus Health System (SAHS) and Saint Alphonsus Health Alliance (SAHA). Coordinates provider contracting functions for SAHA. Responsible for developing strong relationships with provider practices, internal teams, employers, brokers and payors.

Job Description Details:

Skills, Knowledge, Education and Experience:
  • Bachelor's degree required, preferably in Business Administration with a strong background in healthcare administration. 8 years of experience may be considered in lieu of degree.
  • Minimum of 5 years of experience in a healthcare setting preferably in payor/insurer contracting and/or provider contracting, and/or provider network support and development and practice management/administration required.
  • Experience in payor contract language review and contract modeling required.
  • Ability to work collaboratively with internal and external teams.
  • Excellent analytical, presentation, and interpersonal skills.
  • Intermediate computer skills with experience in MS Word, Excel, Access, PowerPoint, Outlook.

  • Essential Functions:
  • Meets Health System's Guiding Behaviors and Caring Standards including interpersonal communication and professional conduct expectations.
  • Establishes relationships with key personnel at provider and payer offices.
  • Develops or evaluates contract proposals and provide comprehensive analysis and recommendations to leadership.
  • Evaluates payor contracts including reimbursement and risk provisions.
  • Develops and implements a contract modeling analysis of the financial terms of proposed contract.
  • Coordinates and participates in contract negotiations and renewals.
  • Maintains contract management software.
  • Stays abreast of legislative activities relevant to healthcare services, healthcare benefit plans and provider networks.
  • Supports SAHS hospital leadership in contract evaluation and negotiations.
  • Responsible for provider contracting activities and communications to include, provider notices, contract updates, and issue resolution.
  • Maintains professional fee schedules.
  • Assists in employee health plan network management.
  • Develops open enrollment and ongoing education regarding network/network changes (employee health plan).
  • Provides education regarding Alliance to potential network providers/practices.

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    Trinity Health's Commitment to Diversity and Inclusion

    Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

    Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.
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