Existing relationships with physician groups in Texas and/or Florida will be helpful
7+ years of experience with health plan or provider organizations
Responsibilities
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Manages contract negotiations with large physician groups and ancillary providers; conducting several negotiations simultaneously to meet growth demands
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Deep understanding and experience with all clinical specialties to ensure contract terms and conditions address the coding structures which are most impacted by negotiations
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Proactively builds relationships that nurture provider partnerships to support the local market strategy
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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
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Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position
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Identify and manages initiatives that improve total medical cost and quality; including renegotiation of existing agreements
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Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms
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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.
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Assists in resolving elevated provider service complaints; researching and negotiating with internal/external partners/customers to resolve complex and/or escalated issues.
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Manages key provider relationships and is accountable for critical interface with providers and business staff
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Coach and support new team members on negotiation strategies and approaches to successful
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Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape
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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
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Bachelor’s degree or equivalent experience in related field, including 7+ years of work experience beyond degree within provider contracting and/or health insurance
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Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
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Experience with Physician group and ancillary provider contracting and negotiations
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Experience negotiating delegated credentialing agreements
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Experience in developing and managing key provider relationships including senior executives
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Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
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Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models
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Team player with proven ability to develop strong working relationships within a fast-paced organization
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The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations
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Customer centric and interpersonal skills are required