Clinical Vendor Management Specialist - Hybrid (PA/NJ/DE)

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Job Summary
The Clinical Vendor Management Financial Analyst is responsible for developing and maintaining financial strategies, analyzing reimbursement trends, and reporting vendor performance for all vendors managed by the Clinical Vendor Management department. This role also serves as a vendor relationship owner for a subset of clinical vendors, ensuring strong partnerships, compliance with policies, and alignment with federal, state, and local regulations.

Key Responsibilities

·       Develop and maintain reimbursement and financial strategies for contracted vendors using knowledge of managed care finance and reimbursement methodologies.

·       Analyze clinical, reimbursement, and savings trends; present findings to internal teams to identify opportunities and recommend improvements.

·       Monitor, evaluate, and report on vendor performance through data analysis and performance metrics.

·       Manage invoice payments and track administrative spend for vendors.

·       Summarize complex analyses into clear, actionable insights to support vendor contract decisions.

·       Collaborate with vendor specialists to document negotiated reimbursement terms into rate exhibits and payment notes.

·       Identify and present cost avoidance and cost recovery opportunities independently or as part of a team.

·       Provide technical assistance and interpretation of vendor payment processes to internal and external stakeholders.

·       Reporting administrative spend, medical cost savings, and ROI by product, month, service, and segment (Fully Insured/Self-Funded).

·       Charge-back amounts and annual revenue for Self-Funded customers in vendor buy-up programs.

·       Authorization patterns and trends from vendors.

·       Membership data accuracy and trends across vendors.

·       Shared-savings program payment tracking and reconciliation.

·       Membership report reconciliation for accuracy.

·       Serve as the primary relationship owner for assigned vendors, ensuring program performance and day-to-day support.

·       Lead vendor contract negotiations and oversee tactical execution of third-party management functions.

·       Ensure compliance with Vendor Management Policies and Procedures and applicable regulations.

·       Act as an advisor to business areas and vendors on performance and contractual matters.

·       May lead projects and train staff in areas of expertise.

·       Perform other duties as assigned.

Required Qualifications

·       Bachelor’s degree in business, Finance, Health Care Management, Information Science, or a related field; Master’s degree preferred.

·       Minimum 5 years of progressive experience, preferably in managed care or provider environments.

·       Strong analytical, technical, and problem-solving skills with experience manipulating and analyzing claims data.

·       Familiarity with managed care and/or Medicare reimbursement terms, concepts, and methodologies.

·       Excellent verbal and written communication skills; comfortable presenting to all levels of management.

·       Ability to work independently and collaboratively in cross-functional teams.

·       Strong organizational skills with the ability to manage multiple projects simultaneously.

·       Detail-oriented with strong interpersonal skills.

·       Advanced proficiency in Microsoft Access, Excel, PowerPoint, and Word.

·       Knowledge or familiarity of SQL, BigQuery, DART, Tableau Reporting, Catalyst, Front Office System (FOS) is a plus