Duties And Responsibilities
- Manages complex contract negotiations with physician groups and facilities commercial product lines (e.g., Ancillaries, large physician groups, some smaller hospitals).
- 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.
- Supports and provides direction to develop network analytics required for the network solution.
- 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.
- Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.
- Assists in resolving elevated and complex provider service complaints. Research problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.
- Manages key provider relationships and is accountable for critical interface with providers and business staff.
- 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.
- Performs other duties as assigned
Position Requirements
- Bachelor’s degree or equivalent experience in related field, plus 5+ years of work
- 5-7 years of experience Negotiate competitive managed care agreements with complex providers, including hospital systems, PHOs, and large IPAs.
- Experience beyond degree within provider contracting and/or health insurance
- Experience with Physician and Ancillary group contracting and negotiations
- Experience negotiating delegated credentialing agreements
- Experience in developing and managing key provider relationships including senior executives
- Existing relationships with hospitals or large physician groups in Texas and/or Florida will be helpful