Sr. Provider Contracting Strategist

Quartz is seeking a healthcare reimbursement expert to join our organization as a Sr. Provider Contracting Strategist.

This critical role willbringadeepunderstandingof the interdependencies between health plan and provider reimbursement strategies and rely on sound financial analysistoadvise upon appropriate contractualtermsthatsupportboth financial performance and high-quality patient care.

This role is ideal fora subject matter expert who can influence and advise atanenterprise-widelevelusing a financial, data-driven approach.

Benefits:

• Work in a collaborative, provider-aligned environment, serving as a liaison focused on building strong partnerships and long-term value for health plan and provider stakeholders
• Serve as a strategic advisor, influencing contracting decisions that directly impact financial outcomes and patient care
• Starting salary based upon skills and experience: $93,000 to $118,000 annually plus robust total rewards package

• Serve as a subject matter expert on provider reimbursement methodologies, contract terms, and financial considerations to advise senior leadership on provider negotiations and network strategy.
• Evaluate and assess provider network contracts for new and existing provider agreements, ensuring mutually beneficial terms that are aligned with current national and local competitive landscape and practices
  • Identify outliers and opportunities for improvement in new and existing provider agreements
  • Perform financial analysis, fee schedule generation, and analytics in accordance with internal modeling and best practice
• Evaluate proposed reimbursement structures and contract changes against internal modeling, historical claims trends, market considerations, and other relevant financial data
• Advise upon provider network design and refinement initiatives by analyzing and producing data-driven recommendations based on clinical information, quality of care and financial performance
  • Develop financial and analytical recommendations that support provider network strategy, provider selection, network development and key contracting decisions
• Advise internal stakeholders on contractual rights, obligations, risks and opportunities, driving continuous improvement and ensuring alignment with company policies and compliance requirements
• Identifies, implements and documents improvements to contracting and reimbursement processes, ensuring best practices and consistency, efficiency, accuracy and effectiveness

• Bachelor’s degree with 4 years of experience with provider reimbursement methodologies, provider contractual terms, or related field using financial analysis, including construction of financial models and reports

Or

• Associate’s degree with 7 years of experience with provider reimbursement methodologies, provider contractual terms, or related field using financial analysis, including construction of financial models and reports

Or

• High School equivalency with 10 years of experience with provider reimbursement methodologies, provider contractual terms, or related field using financial analysis, including construction of financial models and reports
• 5 years of provider reimbursement experience across a variety of providers, including academic medical centers, acute care hospitals, community hospitals, ambulatory surgery centers, and / or critical access hospitals
• Thorough understanding of fully insured and commercial payment methodologies
• Strong financial acumen and advanced analytical capabilities, with the ability to use tools such as Excel, Business Objects, etc. to deliver and support data-driven recommendations
• Enterprise-level thinking: understanding cross-departmental needs and challenges, with the ability to influence decisions and problem solve…