Medical Contract Specialist

1 week ago

Phoenix, Arizona, United States Valenz Full time
About Our Opportunity

We are seeking a highly skilled Medical Contract Specialist to join our Claims team at Valenz. As a key member of our team, you will play a critical role in expanding and maintaining our network of healthcare providers.

Key Responsibilities:

  • Collaborate with management to identify and prioritize network expansion needs, ensuring alignment with our company's strategic objectives.
  • Proactively engage with potential providers to discuss and negotiate contract terms, focusing on building and enhancing our network of healthcare professionals.
  • Analyze the current network composition to identify and address specialty gaps, seeking out a comprehensive provider network that meets the needs of our clients.
  • Negotiate single case agreements with providers, securing favorable terms that benefit our organization and its clients.
  • Demonstrate a thorough understanding of various reimbursement methodologies, including Medicare, DRG, Case Rates, and Per Diems, to ensure accurate and fair contract terms.
  • Employ excellent negotiation skills to secure advantageous contract terms and maintain strong relationships with our provider network.
  • Utilize analytical skills to evaluate contract performance, provider network effectiveness, and potential areas for improvement, providing data-driven insights to inform business decisions.
  • Review and redline contracts, ensuring clarity, accuracy, and compliance with organizational standards and healthcare regulations.
  • Ensure adherence to HIPAA standards and company policies, maintaining confidentiality and security of provider information.
  • Engage in ongoing professional development to stay informed of industry changes and enhance job performance, while also supporting company initiatives and contributing to team efforts.

Requirements:

  • 3+ years of experience in a role focused on network expansion, including healthcare contracting, negotiation, drafting, and management of contracts with healthcare providers.
  • An in-depth understanding of various reimbursement models, such as Medicare, DRG, Case Rates, and Per Diems.
  • Ability to analyze contract terms, reimbursement rates, and network needs, combined with excellent negotiation skills.
  • Familiarity with healthcare regulations, including HIPAA, and the ability to ensure that all contracts comply with these regulations.

Preferred Qualifications:

  • Bachelor's degree in a related field, such as healthcare administration or business.
  • CPC or CIC certification.
  • CMS guideline knowledge.
  • Credentialing experience.

What We Offer:

  • Generously subsidized company-sponsored Medical, Dental, and Vision insurance.
  • Spending account options: HSA, FSA, and DCFSA.
  • 401K with company match and immediate vesting.
  • Flexible working environment.
  • Generous Paid Time Off to include Vacation, Sick, and Paid Holidays.
  • Paid maternity and paternity leave.
  • Community giveback opportunities, including paid time off for philanthropic endeavors.

About Valenz:

We are a company committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. We want everyone engaged within our ecosystem to be strong, vigorous, and healthy. You'll find limitless growth opportunities as we grow together. If you're ready to utilize your skills and passion to make a significant impact in the healthcare self-funded space, Valenz might be the perfect place for you.

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