Provider Contract Specialist (Contract Integrity Reviewer)
Job Description: Legal Contract Specialist - Provider Contracting
Position Summary
The Legal Contract Specialist - Provider Contracting supports the drafting, language review, and administration of provider agreements and related healthcare contracts. This role partners closely with Legal, Provider Contracting, Compliance, and Business teams to ensure contracts are accurate, compliant, and aligned with organizational objectives.
This position is ideal for a detail-oriented professional with experience in healthcare provider contracting, legal contract review, and regulatory compliance.
Key Responsibilities
Contract Drafting & Review
- Draft, review, and revise provider agreements (e.g., physicians, hospitals, ancillary providers)
- Ensure contract terms align with legal requirements, reimbursement structures, and organizational policies
- Identify and mitigate legal and business risks within contract language
- Maintain standard templates and support updates based on regulatory or policy changes
Negotiation & Execution Support
- Support negotiations with providers and third parties in collaboration with contracting and legal teams
- Track revisions, redlines, and approvals through contract lifecycle
- Coordinate execution of agreements and ensure completeness of documentation
Compliance & Regulatory Oversight
- Ensure contracts comply with federal and state regulations (e.g., CMS guidelines, Stark Law, Anti-Kickback Statute where applicable)
- Partner with Compliance and Legal teams to interpret policy changes and incorporate into agreements
- Assist in audits and respond to internal/external inquiries related to provider contracts
Contract Administration
- Maintain contract repository and ensure accurate metadata and version control
- Monitor contract expiration dates, renewals, and amendments
- Generate reports and provide insights on contract status, trends, and risks
Cross-Functional Collaboration
- Serve as a liaison between Legal, Provider Contracting, Finance, and Operations
- Provide guidance to business stakeholders on contract terms and processes
- Support process improvements and standardization initiatives
Qualifications
Required
- Bachelor's degree in Business, Healthcare Administration, Legal Studies, or related field
- 3-6+ years of experience in contract management, legal support, or provider contracting
- Experience reviewing healthcare provider agreements or similar commercial contracts
- Strong understanding of contract lifecycle management (CLM) processes
- Excellent written, analytical, and organizational skills
Preferred
- Experience in managed care, health plans, or healthcare delivery systems
- Familiarity with healthcare regulations (CMS, Medicare/Medicaid, Stark, Anti-Kickback)
- Paralegal certification or JD (not required but a plus)
- Experience with contract management systems (e.g., Ariba, DocuSign CLM, Icertis)
Key Competencies
- Attention to detail and risk awareness
- Contract interpretation and issue spotting
- Stakeholder communication and collaboration
- Ability to manage multiple contracts and deadlines simultaneously
- Problem-solving and process improvement mindset
Work Environment
- Hybrid (ideal) or remote (if applicable)
- Fast-paced, deadline-driven environment requiring high accuracy
FAQs
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