Sr. Provider Contracting Strategist

Overview

Quartz is seeking a healthcare reimbursement expert to join our organization as a Sr. Provider Contracting Strategist. This critical role will bring a deep understanding of the interdependencies between health plan and provider reimbursement strategies and rely on sound financial analysis to advise upon appropriate contractual terms that support both financial performance and high-quality patient care.

This role is ideal for a subject matter expert who can influence and advise at an enterprise-wide level using a financial, data-driven approach.

Benefits:

• Work in a collaborative, provider-aligned environment, serving as a liaison focused on building strong partnerships and long-term value for health plan and provider stakeholders
• Serve as a strategic advisor, influencing contracting decisions that directly impact financial outcomes and patient care
• Starting salary based upon skills and experience: $93,000 to $118,000 annually plus robust total rewards package

Responsibilities

• Serve as a subject matter expert on provider reimbursement methodologies, contract terms, and financial considerations to advise senior leadership on provider negotiations and network strategy.

• Evaluate and assess provider network contracts for new and existing provider agreements, ensuring mutually beneficial terms that are aligned with current national and local competitive landscape and practices

• Identify outliers and opportunities for improvement in new and existing provider agreements

• Perform financial analysis, fee schedule generation, and analytics in accordance with internal modeling and best practice

• Evaluate proposed reimbursement structures and contract changes against internal modeling, historical claims trends, market considerations, and other relevant financial data

• Advise upon provider network design and refinement initiatives by analyzing and producing data-driven recommendations based on clinical information, quality of care and financial performance

• Develop financial and analytical recommendations that support provider network strategy, provider selection, network development and key contracting decisions

• Advise internal stakeholders on contractual rights, obligations, risks and opportunities, driving continuous improvement and ensuring alignment with company policies and compliance requirements

• Identifies, implements and documents improvements to contracting and reimbursement processes, ensuring best practices and consistency, efficiency, accuracy and effectiveness

Qualifications

• Bachelor's degree with 4 years of experience with provider reimbursement methodologies, provider contractual terms, or related field using financial analysis, including construction of financial models and reports

Or

• Associate's degree with 7 years of experience with provider reimbursement methodologies, provider contractual terms, or related field using financial analysis, including construction of financial models and reports

Or

• High School equivalency with 10 years of experience with provider reimbursement methodologies, provider contractual terms, or related field using financial analysis, including construction of financial models and reports
• 5 years of provider reimbursement experience across a variety of providers, including academic medical centers, acute care hospitals, community hospitals, ambulatory surgery centers, and / or critical access hospitals
• Thorough understanding of fully insured and commercial payment methodologies
• Strong financial acumen and advanced analytical capabilities, with the ability to use tools such as Excel, Business Objects, etc. to deliver and support data-driven recommendations
• Enterprise-level thinking: understanding cross-departmental needs and challenges, with the ability to influence decisions and problem solve toward a common goal
• Intellectual curiosity to stay abreast of latest reimbursement methodologies and ability to understand whether they are appropriate for Quartz.
• Preferred licenses: Certified Billing and Coding Specialist (CBCS), Certified Coding Specialist (CCS), Certified Professional Coder (CPC)

Quartz offers an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. To support a safe work environment, all employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified person with disability.