Existing relationships with physician groups in Texas and/or Florida will be helpful

7+ years of experience with health plan or provider organizations

Responsibilities

• Manages contract negotiations with large physician groups and ancillary providers; conducting several negotiations simultaneously to meet growth demands  

• Deep understanding and experience with all clinical specialties to ensure contract terms and conditions address the coding structures which are most impacted by negotiations

• Proactively builds relationships that nurture provider partnerships to support the local market strategy

• Initiates, nurtures, and maintains effective channels of communication with matrix partners including but not limited to, Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing

• Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position

• Identify and manages initiatives that improve total medical cost and quality; including renegotiation of existing agreements

• Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms

• Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities.

• Assists in resolving elevated provider service complaints; researching and negotiating with internal/external partners/customers to resolve complex and/or escalated issues.

• Manages key provider relationships and is accountable for critical interface with providers and business staff

• Coach and support new team members on negotiation strategies and approaches to successful 

• Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape

• Partner with Regulatory Affairs to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity

 

Position Requirements

• Bachelor’s degree or equivalent experience in related field, including 7+ years of work experience beyond degree within provider contracting and/or health insurance

• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen

• Experience with Physician group and ancillary provider contracting and negotiations

• Experience negotiating delegated credentialing agreements

• Experience in developing and managing key provider relationships including senior executives

• Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners

• Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models

• Team player with proven ability to develop strong working relationships within a fast-paced 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