Serves as an integral member of the Provider Contracting Team and reports to the AVP, Provider Contracting.
Assists in developing the strategic direction and management of the day to day contracting and network management activities for a local given territory.
Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers.
Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.
Initiates and maintains effective channels of communication with matrix partners.
Contributes to the development of alternative network initiatives.
Supports and provides direction to develop network analytics required for the network solution.
Creates and manages initiatives that improve total medical cost and quality.
Drives change with external provider partners by assessing clinical informatics and offering consultative expertise.
Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.
Creates healthcare provider agreements that meet internal operational standards and external provider expectations.
Responsible for accurate and timely contract loading and submissions.
Requirements
Should possess a bachelor’s degree; preferably in the areas of Finance, Economics, Healthcare or Business related.
Significant industry experience will be considered in lieu of a bachelor’s degree.
3+ years Managed Care contracting and negotiating experience involving complex delivery systems and organizations required.
Experience in developing and managing key provider relationships
Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred.
Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners.
Intimate understanding and experience with hospital, managed care, and provider business models.
Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization.
The ability to influence both sales and provider audiences through strong written and verbal communication skills.
Experience with formal presentations.
Customer centric and interpersonal skills are required.
Demonstrates an ability to maneuver effectively in a changing environment.
Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
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