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Job Description
Create Your Career With Us!
Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Facility: Cherapa Place Building
Location: Sioux Falls, SD
Address: 300 N Cherapa Pl, Sioux Falls, SD 57103, USA
Shift: 8 Hours – Day Shifts
Job Schedule: Full time
Weekly Hours: 40. 00
Job Summary
Oversees the negotiations of new and renewal contract terms with physicians, hospitals, and other health care providers across the Health Plan footprint, identifying those specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of participating providers that are compliant with applicable state/federal access requirements and built on Sanford Health Plan contract and payment standards to serve the health care needs of Sanford Health Plan membership. Oversees development and execution of provider contracting strategies. Identifies and creates processes to establish links between Contracting and other Plan departments regarding contract requirements. Engages in the development of new reimbursement models jointly with Analytics, IT, Claims, and Public Relations leadership. Communicates new strategies to applicable stakeholders for input, most importantly, key provider stakeholders. Helps implement strategies as needed to achieve desired goals and reduce member access grievances. Ownership the contracting lifecycle, ensuring timely execution and communication of the contract life cycle and revenue capture while actively advising the other Plan departments on decisions relating to contract business/financial terms, legal, and regulatory compliance issues, while having an intimate knowledge of contract terms and issues within their contract. Communicates network and contractual information for company business purposes.
Oversees the maintenance of all Provider Contract Templates. Works with Legal, Corporate and applicable stakeholders, on an as needed basis, to modify contract templates to ensure compliance with the requirements of NCQA, Centers for Medicare and Medicaid Services and other applicable laws and regulatons. Also oversees contract document management of templates and executed agreements.
Qualifications
Bachelor s degree is required with a concentration in healthcare or finance related field preferred.
Must have seven years of relevant experience, superior communication and interpersonal skills. Specific background or experience in healthcare reimbursement and/or contract negotiations would be critical to success in this role.
Benefits
Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, sick leave and paid time off. To review your benefit eligibility, visit https://sanfordcareers.com/benefits .
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to [email protected] .
Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0095694
Job Function: Legal and Compliance
Featured: No
