Provider Contract Negotiator

The Provider Contract Negotiator is responsible for negotiating, administering, and maintaining contracts and relationships (i.e. Primary Care Physician (PCP), specialist, ancillary providers, hospitals) to ensure a high-quality, cost-effective, and compliant provider network. This role supports managed care growth initiatives and organizational goals. Key responsibilities include identifying and onboarding new providers, ensuring regulatory compliance, and fostering strong partnerships with existing partners. The Provider Contract Negotiator will also assist in tracking progress, enhancing brand visibility, and supporting efforts to secure new contracts. Success in this role requires strong communication skills, attention to detail, and a solid understanding of the healthcare industry.

Responsibilities

Negotiating, administering, and maintaining contracts and relationships with Primary Care Physicians (PCP), specialists, ancillary providers, and hospitals; Ensuring a high-quality, cost-effective, and compliant provider network; Identifying and onboarding new providers; Ensuring regulatory compliance; Fostering strong partnerships with existing partners; Assisting in tracking progress; Enhancing brand visibility; Supporting efforts to secure new contracts

Requirements

Bachelor's degree in a related field with 2 years of relevant experience (e.g., provider contracting, contract interpretation, negotiation, client relations) or 3 years of relevant experience in lieu of a degree

Nice to have

Healthcare experience in a Managed Care setting or with a physician group, clinical-based organization, and/or in a hospital/facility setting; Experience with Medicaid, Medicare Advantage, or Commercial provider networks; Experience with contract lifecycle management systems and provider databases; Experience with provider reimbursement methodologies (e.g., fee-for-service, capitation, value-based models); Experience with healthcare regulatory requirements (e.g., CMS, DHCS, DMHC, NCQA) related to provider networks

Benefits

Medical, Dental and Vision insurance; 403(b) Retirement savings plans with employer matching contributions; Flexible Spending Accounts; Commuter Flexible Spending; Career Advancement & Development opportunities; Paid Time Off & Holidays; Paid CME Days; Malpractice insurance and tail coverage; Tuition Reimbursement Program; Corporate Employee Discounts; Employee Referral Bonus Program; Pet Care Insurance