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Provider Contract Jobs in Tennessee (NOW HIRING)

L3Harris Technologies

Principal, Contracts

Nashville, TN · On-site

$86K - $114K/yr

... provide strategic business, contractual, and risk mitigation guidance across the full contract lifecycle for DCS, international commercial contracts. This individual will lead cross-functional teams ...

L3HHCM20

Principal, Contracts

Nashville, TN · On-site +1

$86K - $115K/yr

... provide strategic business, contractual, and risk mitigation guidance across the full contract lifecycle for DCS, international commercial contracts. This individual will lead cross-functional teams ...

Hatch

Contracts Coordinator

Nashville, TN · On-site

... provide contract coordination services following corporate guidelines, procedures, Vale values, principles and policies. Additionally, the Site Contracts Coordinator will be responsible for the ...

Hatch

Contracts Coordinator

Nashville, TN

... provide contract coordination services following corporate guidelines, procedures, Vale values, principles and policies. Additionally, the Site Contracts Coordinator will be responsible for the ...

Hatch

Contracts Coordinator

Nashville, TN · On-site

... provide contract coordination services following corporate guidelines, procedures, Vale values, principles and policies. Additionally, the Site Contracts Coordinator will be responsible for the ...

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All JobsProvider Contract JobsProvider Contract Jobs in Tennessee

Provider Contract information

What is a provider contract?

A provider contract is a formal agreement between a healthcare provider, such as a doctor or hospital, and a health insurance company or managed care organization. This contract outlines the terms under which the provider will deliver medical services to insured members, including reimbursement rates, covered services, and billing procedures. Provider contracts help ensure that patients receive agreed-upon care at predetermined costs and establish the responsibilities of both the provider and the insurer. These agreements are essential for maintaining a network of healthcare professionals who serve plan members.

What are the key skills and qualifications needed to thrive as a provider contract specialist, and why are they important?

To excel as a Provider Contract Specialist, you need strong analytical abilities, knowledge of healthcare regulations, contract negotiation skills, and typically a bachelor's degree in business, healthcare administration, or a related field. Familiarity with contract management software, healthcare reimbursement systems, and proficiency in Microsoft Office are commonly required. Excellent attention to detail, communication, and relationship-building skills help you collaborate effectively with providers and internal stakeholders. These competencies ensure accurate contract execution, regulatory compliance, and mutually beneficial agreements in a complex healthcare environment.

What are some common challenges faced by professionals in provider contract roles, and how can they be addressed?

Professionals in provider contract roles often encounter challenges such as navigating complex regulatory requirements, ensuring contract compliance, and balancing the interests of both healthcare providers and payers. Additionally, they may need to negotiate terms that are both competitive and sustainable for their organization. These challenges can be addressed by staying up-to-date with industry regulations, developing strong negotiation and communication skills, and fostering collaborative relationships with internal legal, compliance, and finance teams.

What is the difference between Provider Contract vs Medical Billing Specialist?

AspectProvider ContractMedical Billing Specialist
CredentialsTypically requires healthcare administration, legal, or business certificationsRequires coding, billing, and healthcare reimbursement certifications
Work EnvironmentHealthcare facilities, insurance companies, or legal officesMedical offices, billing companies, or healthcare providers
Industry UsageUsed in healthcare contracting, negotiations, and legal agreementsUsed in processing insurance claims and patient billing

While Provider Contract specialists focus on creating and managing agreements between healthcare providers and payers, Medical Billing Specialists handle the coding and submission of claims for reimbursement. Both roles are essential in healthcare finance but serve different functions within the revenue cycle.

What are the most commonly searched types of Provider jobs in Tennessee?

The most popular types of Provider jobs in Tennessee are:

Provider Contract jobs near you

Manager-Provider Contracts

Memphis, TN • On-site

Baptist Memorial Health Care Corporation
Hospitals • 10K+ employees

7.3

Company rating: 7.3 out of 10

Based on 115 frontline employees who took The Breakroom Quiz

304th of 893 rated healthcare providers

People enjoy working here

Good employer

Recommended by students

Learn more about Baptist Memorial Health Care Corporationexternal

$92K - $123K/yr

Full-time

Re-posted 2 days ago

Job description

Manager-Provider Relations              

Job Code: 22242        

FLSA Status

Job Family: ADMIN SUPPORT

Job Summary

Identifies, evaluates and negotiates contracting opportunities to grow the existing business, develop new business and expand provider network. In-depth understanding of health care and managed care contracting concepts, reimbursement, methodologies, and health benefit plan designs. Perceptive of general market conditions and the managed care market both provider and payor. Ensures application of appropriate business and legal protocol for contracting services to comply with organization and departmental missions. Serves as liaison for contract communication with other organizational representatives. Manages contract department, support staff, contract document control, and renewal process for payor contracts.

Job Responsibilities

  • Identifies and evaluates managed care contracting opportunities to grow the existing business, develop new business with various third party payors, including but not limited to insurance carriers, third-party administrators, managed care networks, self-funded payors, business alliances and provider organizations and to expand the provider network. Analyzes contract opportunities utilizing contract guidelines in order to improve organization's market share.
  • Negotiates contracts with various providers and third party payors. Manages the necessary interface to bring these negotiated contracts to closure and inform senior management of contract activity.
  • Maintains proficient knowledge of managed care contracting concepts, including but not limited to reimbursement methodologies, e.g., capitation, per diems, DRGs, case rates, and discounted fee-for-service; and, health benefit plan designs, including PPO, POS, EPO and HMO. Extrapolates information from payor's health benefit plans and health care reimbursement arrangements to complete contract summaries, contract information loadsheets and other reports as required to meet organizational obligations.
  • Maintains current knowledge of managed care market and market trends, both provider and payor.
  • Ensures that appropriate business and legal protocol are applied for contracting services to ensure compliance with organization and departmental missions; consults with legal on contracting issues.
  • Serves as liaison for contract communication with other organizational representatives; manages document control of contract file.
  • Manages renewal process for payor contracts, including renegotiation. Analyzes utilization data submitted for contract renewal by following contracting guidelines to monitor contract performance.
  • Performs other duties as assigned.

Specifications

Experience

Description     

Minimum Required: 3 years experience with health care contracting with health care reimbursement and health benefit plan experience.                

Preferred/Desired

Education

Description     

Minimum Required: Bachelors degree in health care administration or business administration.

Preferred/Desired: Masters degree in health care administration or related field

Training

Description     

Minimum Required    

Preferred/Desired

Special Skills

Description     

Minimum Required: Effective in making effective presentations to various provider and payor groups; strong analytical, negotiation, leadership, marketing, and verbal/written communication skills.        

Preferred/Desired

Licensure

Description     

Minimum Required    

Preferred/Desired

Baptist Memorial logo

About Baptist Memorial

Sourced by ZipRecruiter

Baptist Memorial, based in Memphis, TN, US, is a leading health care organization renowned in the healthcare industry. The company's official website is baptistonline.org which provides a comprehensive view of their services and operations. Baptist Memorial operates a myriad of hospitals, health clinics, and medical facilities providing expert and compassionate care. Founded in 1912, it has a rich legacy of over a hundred years of dedication to its community, offering services which include acute care, diagnostic services, and a broad range of speciality health services fulfilling various patient needs.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Memphis, TN, US

View All Baptist Memorial Jobs

What Baptist Memorial Health Care employees say

Pay

Benefits

Hours and flexibility

Workplace

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