Health Plan Provider Contract Management SME

As a technology leader in healthcare process automation and interoperability, Smart Data Solutions (SDS) is a strategic partner that utilizes data and intelligent automation to digitally transform operations and deliver outcomes for clients which reduces costs, streamlines workflows, and improves overall customer experience. Looking to the future, Smart Data Solutions has ambitious growth plans for the next few years and is currently seeking a Health Plan Provider Contract Management SME to join our team!

This individual is someone who has managed provider contracting and provider networking for a health insurance payer. The ideal candidate is a subject matter expert in Healthcare Provider Network management.

What you’ll be doing:

Principal Responsibilities:

• Create and maintain detailed business process documentation for healthcare provider network management processes
• Participate in the design requirements for products to facilitate and automate provider network management workflows
• Advise project teams on key concepts related to provider network management, including:
• Contract management
• Data management
• Performance management
• Act as liaison between customers and product team to ensure network management products deliver value to the market
• Execute role of product owner for network management automation products
• Other duties as assigned

What we’re looking for:

Required skills:

• At least 5 years of healthcare business process experience, with particular experience in provider network management
• Professional experience and familiarity with provider network management workflows, current market solutions/toolsets, and existing market challenges
• Demonstrated achievements in business process implementation and improvement, particularly with provider network management workflows
• High level of professional communication skills; written and verbal
• Ability to have “tough” conversations
• Continual sense of urgency
• Ability to work independently and cooperatively
• Strong interpersonal skills

Why this is the company for you:

Top Benefits & Perks:

• A company culture that is authentic and values teamwork, humility, and fairness! We work hard for our customers and have fun along the way!
• A professional development and growth-oriented workplace
• Generous benefits including, health insurance, dental insurance, vision insurance, short-term, and long-term disability
• 401(k) with a company match to provide a better future in your retirement years
• Work-life balance with competitive paid time off package; including vacation, holiday, give back volunteer day, and a floating day

Who is Smart Data Solutions?

Smart Data Solutions is a technology vendor that brings 22 years of healthcare experience using intelligence and automation to extract data from front-office mailroom operations. Today, the company is expanding out from its front office focus and targeting its open-source automation and AI engines toward the entire healthcare operations value chain. One of the key benefits of working with Smart Data Solutions is their specialized approach to data capture and automation. Smart Data Solutions takes a comprehensive approach to image and document processing, using multiple engines and hundreds of thousands of lines of code to ensure accuracy and make sense of data. Smart Data Solutions has also invested heavily in EDI interoperability, with clearinghouse capabilities that enable them to pivot towards providing value-added services. Using the data they have collected, they are able to offer population health insights to clients, helping them make informed decisions about their largest areas of spending and identifying potential opportunities for cost savings.

Smart Data Solutions’ global headquarters are just outside of St. Paul, MN with 400+ employees and leverages dedicated onshore and offshore resources as part of its service delivery model. The company counts over 500 healthcare organizations as clients, including multiple Blue Cross Blue Shield state plans, regional health plans, and TPAs, handling over 2 billion transactions of varying types annually with a 98%+ customer retention rate. SDS plans to continue investments into meaningfully in automation and machine learning capabilities across its tech-enabled processes to drive scalability and greater internal operating efficiency while also improving client results.

SDS has partnered with a leading growth-oriented investment firm, Parthenon Capital Partners, and the Blue Venture Fund, a unique collaboration among Blue Cross Blue Shield (BCBS) companies, to further accelerate expansion and product innovation.

Location:

Smart Data Solutions is located in Eagan, MN. This is a remote position.

Smart Data Solutions is an equal-opportunity employer.

All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or another legally protected status.