Provider Contract Specialist Mgr at Elevance Health

Indianapolis, Indiana, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

H.S. diploma or equivalent and a minimum of 5 years of experience with provider contracts, plan procedures, and policies; or any combination of education and experience, which would provide an equivalent background
Critical thinking skills
Proven strong eye for detail
Focus on quality

Responsibilities

Manage negotiated pricing loads with expertise
Coordinate the process for the most complex pricing arrangements involving facilities or large health systems, or high-profile provider groups and/or physician groups tied to large hospital systems joining the network
Create standard contracts for providers as needed
Manage provider update files submitted by delegated provider entities and/or large groups/integrated delivery system
Prepare 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
Work 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
Perform internal audit of provider record, ensuring accuracy against rosters
Serve as the go-to with matrix partners to resolve interpretation issues and ensure timely turnaround
Serve as local market expert supporting (and managing when necessary) the provider onboarding process and provider updates submitted by provider offices within defined market

Skills

Key technologies and capabilities for this role

Provider ContractingPricing ArrangementsContract LoadingProvider Data ManagementFee for Service AgreementsValue Based AgreementsInternal AuditingNetwork Provider ManagementHealthcare ContractsProvider Rosters

Questions & Answers

Common questions about this position

What is the work arrangement for this role?

This role requires associates to be in-office 1-2 days per week in Indianapolis, Indiana, to foster collaboration while providing flexibility for virtual work. Candidates not within a reasonable commuting distance from the location will not be considered unless an accommodation is granted.

What experience is required for the Provider Contract Specialist Mgr position?

A minimum of 5 years of experience with provider contracts, plan procedures, and policies is required, or any combination of education and experience providing an equivalent background. An H.S. diploma or equivalent is also needed.

What are the main responsibilities of this role?

The role involves managing complex pricing arrangements for facilities, health systems, and provider groups, coordinating provider update files, ensuring accurate contract loading, performing internal audits, and serving as a market expert for provider onboarding.

What skills are essential for success in this position?

Critical thinking skills, a proven strong eye for detail, and a focus on quality are essential.

What is the salary or compensation for this role?

This information is not specified in the job description.

What makes a strong candidate for this role?

Strong candidates will have 5+ years of direct experience with provider contracts, procedures, and policies, along with critical thinking, attention to detail, and quality focus to handle complex pricing and auditing tasks.

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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