Contracting Specialist

About Wvumedicine

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Job Summary

Plays a critical role in developing a network for our members and providers. Reporting to the Manager of Contracting you will be a critical part of the Provider Relations team. The ideal candidate for this role is a passionate, community oriented and has direct health plan managed care contracting experience.

Key Responsibilities

• Analyze contracts between Peak Health and its network providers for the various Peak Health products.
• Analyze data from various sources and systems for both physician and hospital services in order to present reports to key management and staff.
• Recommend and implement solutions to assist in the contracting decision-making process.
• Conduct negotiations with hospitals, physicians and ancillary providers on behalf of Peak Health.
• Present healthcare data in a meaningful, concise and beneficial manner to upper management.
• Utilize data to provide consulting service and decision support on healthcare.

Requirements

• Bachelor’s degree in Business Administration, Health Care Management OR High School Diploma and equivalent work experience.
• One (1) year of work experience in healthcare data analytics, healthcare consulting analytics or healthcare contracting analytics.
• One (1) year of related healthcare insurance experience in related contractual, financial or provider related activities with major healthcare insurance companies.

Preferred Qualifications

• Direct experience in data analysis, financial analysis and reporting.
• Progressive experience in health care management, physician groups, hospitals, payer contract negotiations.
• Consulting and/or healthcare decision support work experience in the healthcare industry preferred.