Network Contracting Specialist

Job Description

Job Description

Job Summary :

The intent of this job description is to provide a summary of the major duties and responsibilities performed in this job. Incumbents may be requested to perform job-related tasks other than those specifically presented in this description.

The Network Contracting Specialist is responsible for developing, negotiating, and maintaining provider network agreements to ensure adequate access, competitive cost structures, and compliance with regulatory standards. This role serves as a liaison between the organization and healthcare providers, supporting strategic initiatives for network growth and cost containment.

Essential Job Duties : Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Contract Negotiation & Management : Negotiate contracts with physicians, physician groups, and ancillary providers; prepare, execute, and track provider agreements, amendments, and fee schedules; analyzefinancial impactof contract terms and alternative reimbursement models; ensuretimelyrenewals and manage contract expirations.
• Network Development : Recruit providers to meet network adequacy and access requirements;maintainstrong relationships with providers and internal stakeholders; support credentialing coordination and onboarding processes.
• Compliance & Data Integrity : Ensure contractscomply withstate and federal regulations (e.g., Medicare, Medi-Cal); maintainaccurateprovider data in internal systems;assistwith audits and regulatory reporting related to network adequacy.
• Operational Support : Prepare reports and presentations on contracting activities; collaborate with Claims, Medical Management, and Compliance teams; resolve escalated provider service issues and inquiries.

Required education and experience : The requirements listed below are representative of the knowledge, skills, and / or ability required.

Minimum Education required :

Minimum Experience Required :

Minimum Knowledge and Skills Required :