Specialist, Contract Administration 


Location: Raleigh, NC

 

Position Purpose:

Coordinate and negotiate physician (individual providers, single-specialty, and multi-specialty groups) and ancillary service agreements that are in accordance with Carolina Complete Health Network, health plan and State guidelines.  This position reports to Manager, Network Services.

 

·       Recruit, develop, and maintain healthcare provider network plan for region and set of providers.

·       Identify and initiate contact with potential providers.

·       Negotiate contracts.

·       Leads assigned negotiations (i.e., physician and ancillary) and ensure that negotiations result in the unit cost targets expected and meet the objectives of Carolina Complete Health Network.

·       Facilitate and provide oversight to the provider set-up and contract configuration to ensure accurate claims adjudication.

·       Evaluate and monitor providers’ performance standards and financial performance of contracts.

·       Coordinate with internal departments and contracted providers to implement and maintain contract compliance.

·       Maintain and update on a routine basis the contract organization’s database.

·       Assist with and track credentialing activities.

·       Facilitate the organization of provider focus groups.

·       Coordinate with internal departments and contracted healthcare providers to implement and maintain contract compliance.

·       May require 5 - 25% travel

 

Qualifications:

Education/Experience: Bachelor’s degree in Healthcare Administration, Business Administration, Marketing, related field, or equivalent experience. 2+ years of contracting, provider relations or other related experience preferably in a healthcare, managed care, or insurance related environment.


 

Carolina Complete Health Network is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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