Contract Specialist

Valenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity, and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan, and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality, and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.
 

About Our Opportunity

As a Contract Specialist on our Claims team, you’ll will work on expanding and maintaining the network of providers for the organization. You’ll focus on contracting with both facility and physician providers in specific areas, analyzing the network to identify specialty gaps, and negotiating single case agreements to meet client needs. You will provide expertise of various reimbursement methodologies, along with strong negotiation and analytical skills to ensure effective contract management and compliance with healthcare standards.
 

Things You’ll Do Here:

• Collaborate with management to identify and prioritize network expansion needs.
• Proactively reach out to potential providers to discuss and negotiate contract terms, focusing on building and enhancing the network.
• Analyze the current network composition to identify and address specialty gaps, seeking out a comprehensive provider network.
• Negotiate single case agreements with providers, focusing on favorable terms for the organization and its clients.
• Demonstrate a thorough understanding of reimbursement methodologies, including Medicare, DRG, Case Rates, and Per Diems, to ensure accurate and fair contract terms.
• Employ excellent negotiation skills to secure advantageous contract terms and maintain provider relationships.
• Utilize analytical skills to evaluate contract performance, provider network effectiveness, and potential areas for improvement.
• Review and redline contracts, ensuring clarity, accuracy, and compliance with organizational standards and healthcare regulations.
• Ensure adherence to HIPAA standards and company policies, maintaining confidentiality and security of provider information.
• Engage in ongoing professional development to stay informed of industry changes and enhance job performance, while also supporting company initiatives and contributing to team efforts.

Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.

What You’ll Bring to the Team:

• 3+ years of experience in a role focused on network expansion including healthcare contracting, including negotiating, drafting, and managing contracts with healthcare providers.
• An in-depth understanding of various reimbursement models, such as Medicare, DRG, Case Rates, and Per Diems.
• Ability to analyze contract terms, reimbursement rates, and network needs, combined with excellent negotiation skills.
• Familiarity with healthcare regulations, including HIPAA, and the ability to ensure that all contracts comply with these regulations.

A plus if you have:

• Bachelor’s degree in related field.
• CPC or CIC certification
• CMS guideline knowledge
• Credentialing experience

Where You’ll Work

This is a fully remote role.
 

Why You Will Love Working Here

We offer employee perks that go beyond standard benefits and compensation packages – see below!

At Valenz, our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. We want everyone engaged within our ecosystem to be strong, vigorous, and healthy. You’ll find limitless growth opportunities as we grow together. If you're ready to utilize your skills and passion to make a significant impact in the healthcare self-funded space, Valenz might be the perfect place for you!
 

Perks and Benefits

• Generously subsidized company-sponsored Medical, Dental, and Vision insurance.
• Spending account options: HSA, FSA, and DCFSA
• 401K with company match and immediate vesting.
• Flexible working environment.
• Generous Paid Time Off to include Vacation, Sick, and Paid Holidays.
• Paid maternity and paternity leave.
• Community giveback opportunities, including paid time off for philanthropic endeavors.

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.

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