Provider Contract Management Specialist

Work from home within Oregon, Washington, North Dakota, Idaho or Utah

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Every day, Cambia's dedicated team of Provider Contract Managers are living our mission to make health care easier and lives better. As a member of the Network Operations team, our Provider Contract Management Specialists supports the accurate development, execution, and maintenance of healthcare provider contracts, including database management, regulatory filings, and audit support. This role also conducts research to resolve contract-related issues and provides training to internal teams on contract management systems and processes – all in service of creating an economically sustainable health care system.

Do you have a passion for system optimization and process improvement? Are you energized by sharing your expertise through mentoring and cross-functional collaboration? Then this role may be the perfect fit.

• The Provider Contract Management Specialist would have a/an Bachelor's Degree in healthcare, business or related field and 3 years experience in the healthcare industry with a minimum of one year project-related experience, or equivalent combination of education and experience.

• Proficient in Microsoft Office and corporate software, with strong skills in grammar, formatting, and report preparation
• Action-oriented with the ability to organize, prioritize, and meet deadlines while producing accurate, detail-focused work
• Excellent oral and written communication skills for interfacing with internal and external contacts, including state regulatory bodies
• Strong teamwork and collaboration skills with peers, leadership, and cross-functional teams
• Proficient in contract management systems, including loading contract types, payment methodologies, document templates, and system reporting
• Skilled in contract filing software to manage regulatory compliance and state filing requirements accurately
• Familiarity with the Regence provider community, contracting protocols, reimbursement methodologies, and contract development processes desired
• Experience with AI tools and technologies to enhance productivity and decision-making highly desired

• Prepares, configures, and maintains provider contract documents and templates in the contract management system, including technical coding, sub-coding, and system configuration to ensure accurate contract language, rates, and reporting capabilities
• Conducts peer reviews and system testing of documents, templates, and configurations prior to production deployment to minimize contractual, administrative, and regulatory risks
• Implements and coordinates provider contracts and reimbursement with Provider Operations, Provider Pricing, and Provider Enrollment staff, including annual fee schedule updates
• Works cross-functionally with Network Management, Legal, and Regulatory Compliance teams to draft, coordinate, file, and revise provider contracts in compliance with state Insurance Commissioner requirements
• Serves as the central point of contact for contract management system training, troubleshooting, and support, including developing training materials and conducting virtual sessions
• Maintains the integrity and accuracy of the provider contract database and repository, conducting ongoing audits and communicating updates to Network Management and other divisions
• Supports internal and external audits, triages claims and audit inquiries, processes Single Case Agreements, and assists with mass mailings across all Plans
• Develops and maintains contract policies, procedures, and desk references, enforces business requirements and standards, and assists with stakeholder coordination on contract language, operational standards, and data governance

Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.

Oregon, Washington, Utah, and Idaho:
The expected hiring…