Provider Network Specialist III

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.

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., * 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.

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.