What are the responsibilities and job description for the Managed Care Contract Specialist position at P3 Health Partners Brand?
Overall Purpose:
The Managed Care (Network) Contract Specialist is responsible for overseeing the contractual relationships between the organization and healthcare providers. This role includes negotiating, drafting and administering contracts with providers to ensure they meet organizational standards and comply with regulatory requirements. The Managed Care (Network) Contract Specialist also works closely with various departments to ensure smooth network operations and facilitates provider onboarding, network growth, and compliance.
Essential Functions:
- Negotiate, draft and execute provider agreements (e.g. physician groups, hospitals, specialists, etc.)
- Ensure compliance with federal and state regulations and organizational policies during contract development and execution.
- Assist in the review and update of contracts to maintain compliance with evolving industry regulations and organizational needs.
- Develop and maintain positive, long-term relationships between the organization, health plans and healthcare providers.
- Address and resolve provider inquiries, concerns or disputes related to contracts, reimbursement, etc.
- Assist with training and development of external provider education programs.
- Assist with identifying and contracting new providers to grow the network and meet organizational goals.
- Analyze network needs and assist in making strategic decisions about provider network expansion.
- Maintain and update accurate records of contracts, amendments and provider agreements in the organizations contract management system.
- Generate reports on contract status, compliance and provider performance as needed.
- Monitor and ensure that provider contracts adhere to regulatory standards and organizational policies.
- Assist with audits and reviews of provider contracts to ensure accuracy and compliance.
- Address any contractual issues that may arise and recommend solutions.
- Collaborate with internal teams (e.g. legal, compliance, finance, provider relations, etc.) to ensure contract terms are consistent with organizational objectives, smooth claim processing and dispute resolution.
- Delivers assigned projects on time and compliant to applicable state and federal regulations.
- Organizes and prioritizes large volumes of information.
- General administrative duties as assigned.
Knowledge, Skills, and Abilities:
- Strong negotiation and communication skills (both written and verbal).
- Knowledge of healthcare provider contracts, reimbursement models, and regulatory requirements (e.g., HIPAA, CMS, state-specific regulations).
- Excellent attention to detail and organizational skills.
- Ability to analyze data and prepare reports.
- Strong problem-solving skills and ability to manage multiple projects simultaneously.
- Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and contract management software.
Experience:
- Must have a minimum of five years’ work experience in healthcare contracting or network management in a managed care setting.
- Experience in contract negotiation, provider network development and healthcare reimbursement systems.
Education:
- Bachelor's Degree in Business Administration, Healthcare management, or related field.
Travel:
- Travel may be required to engage with potential clients, develop relationships with physicians, clinical teams, etc. and overall build the organization.
About P3:
People. Passion. Purpose.
At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization, then you should consider joining our team.
