Responsibilities

• Manage the provider contracting process for a rapidly growing health plan, including
  • Assuring that negotiators are efficient in their use of the correct documents
  • Assuring that contracts are meeting standards
  • Assuring contracts flow smoothly through the processes and that Claims
    Operations can load the contract into our claim system.
• Collaborate with network contracting colleagues, as well as legal department, compliance, credentialing and claim operations to optimize and streamline the contracting process.
• Establish an end-to-end provider contract review policy and procedure incorporating the negotiation of language and rates to the entry in the claim system
• Manage all policies and procedures impacting the network development and credentialing teams; including development of new processes
• Lead the market fee schedule governance committee and ensure compliance with federal and state regulations
• Own and update the provider resources, as needed, to comply with regulations or expansion; including but not limited to the Provider Manual
• Identify potential risks associated with contracting activities and propose mitigation strategies
• Assist with internal and external audits
• Partner with Compliance to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity
• Create and maintain a library of approved “Model Contracts” for hospitals, physicians/group, and ancillary providers
• Reduce/eliminate rework or mitigation of unfavorable contract terms over time

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
• Remote with occasional travel (5%)
• 7+ years of experience with health plan or provider organizations
• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
• Experience with physician group and ancillary provider contracting language and reimbursement
• Experience reviewing delegated credentialing agreements
• Demonstrated experience in seeking out, building and nurturing strong internal and external relationships
• Team player with proven ability to develop strong working relationships within a fast-paced organization
• Customer centric and interpersonal skills are required.