Senior Provider Relations/Contract Specialist

Senior Provider Relations/Contract Specialist

This is a full-time, benefit eligible position that is partial remote located at our 4S Ranch office. Why join Scripps Health? At Scripps Health, your ambition is empowered and your abilities are appreciated: Nearly a quarter of our employees have been with Scripps Health for over 10 years. Scripps is a Great Place to Work Certified company for 2025. Scripps Health has been consistently ranked as a top employer for women, millennials, diversity, and as an overall workplace by various national publications. Becker's Healthcare ranked Scripps Health on its 2026 list of 150 top places to work in health care. We have transitional and professional development programs to create a learning environment that enables you to thrive in your specific field as well as in your overall career. Our specialties have been nationally recognized for quality in areas such as cardiovascular care, oncology, orthopedics, geriatrics, obstetrics and gynecology, and gastroenterology. The Senior Provider Relations/Contract Specialist is the liaison between the medical groups, network providers and Scripps Clinic Health Plan Services. Decision making authority regarding processes related to the contractual arrangements. Responsibilities may include, but are not limited to: reporting, auditing, documentation, communication, training and effective resolution of issues. Ensures exceptional customer service and builds effective relationships between the organizations. Attends meetings at medical groups to provide input and support in relation to managed care. Thoroughly researches issues and interacts with management in Managed Care Operations to facilitate effective processes. Assists in network contracting ensuring ease of implementation of contracts and standardization of rates whenever possible.

Qualifications:

• Required Education/Experience/Specialized Skills: Bachelor's degree in business/health care field or equivalent experience. Minimum 5 years managed care experience. Exceptional customer service skills with proven ability for effective follow-up. Claims payment, contract interpretation and knowledge of contracting terms required.
• Preferred Education/Experience/Specialized Skills/Certification: Experience with Provider Relations. Worked for a Medical Group or Health Plan. Epic Tapestry experience. Contract financial modeling experience.