Provider Contract Specialist (US)
Elevance Health

Job Info

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Provider Contract Specialist

Location: Seven Hills, OH; Mason, OH & Cincinnati, OH

This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of the Elevance Health PulsePoint locations listed above.

The Provider Contract Specialist will be responsible for coordinating the process for new and existing providers joining the network including creating standard contracts for providers as needed.

How you will make an impact:

• Manage provider update files submitted by delegated provider entities and/or large groups/integrated delivery system as needed
  
• Prepare the information for timely and accurate submission to the Provider Data Management area.
  
• Ensure updates/changes for existing network providers are interpreted and loaded accurately.
  
• Ensure accurate and timely loading of professional and facility contracts across value based and fee for service agreements for provider solutions.
  
• Works directly with contracting directors and managers to understand what is negotiated and how the negotiated agreement is translated into the company's systems resulting in accurate and timely loading.
  
• Performs internal audit of provider record, ensuring accuracy against rosters.
  
• Serves as the go-to with matrix partners to research and resolve data loading errors, and ensure timely turnaround.
  
• Serve as local market expert supporting and managing the provider onboarding process and provider updates submitted by provider offices within defined market.
  
• Assist with Departmental project/initiatives as needed
  

Minimum Requirements:

• Requires a H.S. diploma and a minimum of 2 years experience with provider contracts, plan procedures, and policies; or any combination of education and experience, which would provide an equivalent background.
  

Preferred Qualifications:

• Strong organizational skills and ability to handle multiple priorities preferred.
  
• Strong excel skills preferred.
  
• Critical thinking and problem solving skills preferred.
  
• Health insurance knowledge preferred.
  
• SPS/PLM knowledge helpful preferred.
  

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