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Provider Network Specialist III @ Sutterhealth

Emeryville, California, USOnsiteFull-time
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About this role

We are so glad you are interested in joining Sutter Health!

Organization

SHSO-Population Health Services-Bay

Position Overview

Is responsible for the contract management of provider network agreements and negotiation of contract Letter of Agreements (LOAs). The primary focus is to assure the availability of contracted primary care and specialty providers to meet the geographic demand of the managed care contracts and other risk contracts under design. Provides analytical support budgeting and contracting. May assist in special projects as assigned.

Job Description

EDUCATION

Equivalent experience will be accepted in lieu of the required degree or diploma.

  • Bachelor's: Business Administration, Healthcare Management, Finance or related field

TYPICAL EXPERIENCE

  • 5 years recent relevant experience.

SKILLS AND KNOWLEDGE

  • Working knowledge of health care, especially managed care principles, in particular the provider and HMO relationship and Medicare/Medi-Cal principals.
  • Problem solving skills including financial, business, and contract analysis.
  • Knowledge of health care contract and billing terminology, provisions and reimbursement methodologies including managed care risk contracting and workers compensation.
  • Ability to work in a fast-paced, complex health care setting.
  • Knowledge of PC hardware and software including MS Office (Word, PowerPoint and Excel), and the operation of a fax machine, scanner, and copier.
  • Organizational skills and the ability to balance numerous priorities at a given time with minimal supervision.
  • Ability to field questions and translate those into meaningful action and solutions.
  • Ability to independently assess and structure data from diverse sources.

Job Shift

Days

Schedule

Full Time

Days of the Week

Monday - Friday

Weekend Requirements

None

Benefits

Yes

Unions

No

Position Status

Exempt

Weekly Hours

40

Employee Status

Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $111,592.00 to $167,398.40 / annual salary. Sacramento Valley Pay Range is $97,032.00 to $145,558.00 / annual salary.

The posted pay range is based on the position's primary work location. Candidates who reside and work outside of that location may be subject to a different pay range based on their work location. Candidate starting salaries consider multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.

Skills

contract managementNegotiationmanaged care principlesMedicare/Medi-Calcontract analysisreimbursement methodologyworkers compensationMicrosoft Office

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