Provider Contract Management Specialist

Overview

This is a remote position available for candidates residing in Oregon, Washington, North Dakota, Idaho, or Utah. The role focuses on supporting the development, execution, and maintenance of healthcare provider contracts within the Network Operations team. Responsibilities include managing contract databases, regulatory filings, audit support, research to resolve contract issues, and providing training on contract management systems and processes.

Responsibilities

• Prepare, configure, and maintain provider contract documents and templates in the contract management system, including technical coding and system configuration to ensure accuracy in contract language, rates, and reporting.
• Conduct peer reviews and system testing of documents and configurations before production deployment to reduce contractual, administrative, and regulatory risks.
• Coordinate provider contracts and reimbursement processes with Provider Operations, Provider Pricing, and Provider Enrollment teams, including annual fee schedule updates.
• Collaborate cross-functionally with Network Management, Legal, and Regulatory Compliance teams to draft, file, and revise provider contracts in compliance with state Insurance Commissioner requirements.
• Serve as the central contact for contract management system training, troubleshooting, and support; develop training materials and conduct virtual sessions.
• Maintain the accuracy and integrity of the provider contract database and repository through ongoing audits and communication with Network Management and other divisions.
• Support internal and external audits, manage claims and audit inquiries, process Single Case Agreements, and assist with mass mailings across all plans.
• Develop and maintain contract policies, procedures, and desk references; enforce business requirements and standards; assist with stakeholder coordination on contract language, operational standards, and data governance.

Requirements

• Bachelor's Degree in healthcare, business, or a related field.
• Minimum of 3 years of experience in the healthcare industry, including at least 1 year of project-related experience, or an equivalent combination of education and experience.
• Proficiency in Microsoft Office and corporate software, with strong grammar, formatting, and report preparation skills.
• Ability to organize, prioritize, and meet deadlines while producing accurate, detail-oriented work.
• Excellent oral and written communication skills for interaction with internal and external contacts, including state regulatory bodies.
• Strong teamwork and collaboration skills with peers, leadership, and cross-functional teams.
• Proficiency in contract management systems, including loading contract types, payment methodologies, document templates, and system reporting.
• Experience with contract filing software to manage regulatory compliance and state filing requirements.

Preferred Qualifications

• Familiarity with the Regence provider community, contracting protocols, reimbursement methodologies, and contract development processes.
• Experience with AI tools and technologies to enhance productivity and decision-making.

Compensation & Benefits

• Pay ranges vary by work location and candidate qualifications.

  • Oregon, Washington, Utah, and Idaho: Expected hiring range $30.30 - $31.50 per hour; full salary range $28.40 - $46.30 per hour; bonus target 10%.
  • North Dakota: Expected hiring range $29.00 - $31.00 per hour; full salary range $26.03 - $41.60 per hour.

• Benefits include medical, dental, and vision coverage for employees and eligible family members, including mental health benefits.

• Annual employer contribution to a health savings account.

• Generous paid time off plus 10 company-paid holidays.

• Market-leading retirement plan with company match on 401(k) contributions and potential discretionary contributions.

• Up to 12 weeks of paid parental leave (eligibility requires 12 months of continuous service).

• Wellness programs, employee assistance fund, and commute/parking benefits.

Additional Information

• This role requires a wired internet connection (no satellite or cellular) with minimum upload speed of 5 Mbps and download speed of 10 Mbps.
• New hires must have access to a personal mobile device to set up Multi-Factor Authentication (MFA) for system security.
• The employer is an Equal Opportunity employer committed to a drug and tobacco-free workplace.
• A background check is required.
• Accommodation is available for applicants with medical conditions or disabilities during the application process upon request.

Location

Remote work within Oregon, Washington, North Dakota, Idaho, or Utah.