What Is a Network Contractor and How to Become One

By ZipRecruiter Marketplace Research Team

As a network contractor, you manage budgets, set targets, and report on performance and financial models for a health care business. Your responsibilities include predicting emerging customer needs, for which you collect and analyze provider data. You develop competitive, stable networks able to meet unit cost performance and trend management goals. Other duties include negotiating contracts with providers in compliance with company policies and reimbursement structure standards, and ensuring a wide distribution of provider specialties. You evaluate and resolve escalated client issues. Some positions require you assist end-to-end provider claims, enhance call quality, and improve the ease of physician portal use if relevant.

Qualifications needed to become a network contractor include a bachelor’s degree and at least three years of experience working in a network management-type role. Some employers require that you have knowledge of health care or managed care. You should have experience with fee schedule development and with using financial models and analysis to negotiate provider rates. It is critical that you understand claims processing systems and guidelines. Some jobs require you to have thorough working knowledge of Medicare Resource-Based Relative Value System (RBRVS) reimbursement, as well as Medicare and Medicaid regulations. It is also vital to have strong communication skills.