Network Contracting Specialist
Posted on Thursday, November 9, 2023
Duties And Responsibilities
- Manages contract negotiations with physician groups. Conducting several negotiations simultaneously to meet growth demands.
- 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.
- Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.
- Assists in resolving elevated provider service complaints. Research problems and negotiates 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.
- 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
- Bachelor’s degree or equivalent experience in related field, plus 5+ years of work experience beyond degree within provider contracting and/or health insurance
- Experience with Physician group 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 Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
- Remote with occasional travel (5%)
- Existing relationships with physician groups in Texas and/or Florida will be helpful