Provider Contract Spec Manager – IN HCN

Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Provider Contract Spec Manager functions with the expertise in managing negotiated pricing loads. Responsible for coordinating the process for the most complex pricing arrangements involving facilities or large health systems, or high profile provider groups and/or physician groups tied to large hospital systems joining the network including creating standard contracts for providers as needed.

• Manage provider update files submitted by delegated provider entities and/or large groups/integrated delivery system.
• Prepare the information for timely and accurate submission to the Provider Data Management area.
• Ensure updates/changes for existing network providers are interpreted and loaded accurately.
• Ensure accurate and timely loading of professional and facility contracts across value based and fee for service agreements for provider solutions.
• Works directly with contracting directors and managers to understand what is negotiated and how the negotiated agreement is translated into the company's systems resulting in accurate and timely loading.
• Performs internal audit of provider record, ensuring accuracy against rosters.
• Serves as the go-to with matrix partners to resolve interpretation issues and ensure timely turnaround.
• Serve as local market expert supporting (and managing when necessary) the provider onboarding process and provider updates submitted by provider offices within defined market.
• Must possess critical thinking skills, have a proven strong eye for detail and a focus on quality.

Requires a H.S. diploma or equivalent and a minimum of 5 years of experience with provider contracts, plan procedures, and policies; or any combination of education and experience, which would provide an equivalent background.

• Previous experience working with provider pricing and reimbursement preferred.
• Experience with provider contracts and system configuration preferred.
• Experience with healthcare claims operations.
• Experience using the following systems highly preferred: SPS, PI, Tableau, WGS, GBD FACETS, MS Excel

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability,…