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Lumeris

Value-based care management via PHSO platform

In-Market Provider Contract Analyst

Contract ManagementUpdated on Nov 12
Full-time

About the Job

Requirements

  • At least 5 years of relevant experience in managed care, a health plan, or a provider organization.
  • Practical working knowledge of provider contract language, reimbursement methodologies, and managed care principles.
  • Ability to interpret contract data and solve moderately complex problems with limited supervision.
  • Organizational skills and ability to prioritize and manage multiple competing deadlines.
  • Bachelor's degree or equivalent experience.

Responsibilities

  • Manage a dedicated portfolio of ancillary, professional, and facility provider contracts, independently handling negotiations for renewals and new standard agreements.
  • Analyze and interpret contract terms, rate proposals, and reimbursement methodologies to determine appropriate action and ensure alignment with organizational standards.
  • Resolve moderately complex provider inquiries about contract interpretation, reimbursement, and operational setup, serving as a knowledgeable point of contact.
  • Partner with Provider Partnership Liaisons to ensure a smooth, professional handoff and onboarding for newly contracted providers.
  • Maintain the integrity and accuracy of contract data in the contract management system for downstream reporting and analysis.
  • Identify and recommend opportunities to improve contracting processes, templates, and workflows to increase efficiency and accuracy.

About the Company

Lumeris

Value-based care management via PHSO platform

Lumeris provides value-based care management as a services operator for health systems and physician groups, offering technology, services, and risk management to shift from fee-for-service to value-based models. Its Population Health Services Organization (PHSO) combines an AI-powered platform called Tom with workflows and expertise to coordinate care, surface best next actions like screenings, and reduce administrative burden. It differentiates itself through risk-sharing partnerships with providers and payers and by leveraging Essence Healthcare’s proven value-based care approach at scale, managing over $13 billion in medical spend and serving more than a million patients. Its goal is to expand the adoption of value-based care by forming broader risk-based partnerships that improve clinical outcomes while controlling costs.

Company size
1,001-5,000
Company stage
Late Stage VC
Total funding
$507M
Headquarters
Maryland Heights, MO
Founded
2001

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