Offer summary

Qualifications:

Bachelor’s degree or equivalent experience in a related field., 7+ years of experience in provider contracting and/or health insurance., Current Georgia hospital contracting experience is required., Superior problem-solving, decision-making, and negotiating skills. .

Key responsabilities:

Manage contract negotiations with major health systems and large physician groups.

Build and maintain relationships with providers to support local market strategy.

Prepare and analyze financial impacts of complex provider contracts.

Collaborate cross-functionally to manage provider compensation and pricing development.

Job description

Remote with occasional travel (5-10%)

Existing relationships with Major Health Systems and Large Physician Groups across Georgia required.

7+ years of experience with health plans and provider organizations.

Duties And Responsibilities

Manages contract negotiations with Major Health System and large physician groups and ancillary providers; conducting several negotiations simultaneously to meet growth demands
Deep understanding and experience with all clinical specialties to ensure contract terms and conditions address the coding structures which are most impacted by negotiations
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; including renegotiation of existing agreements
Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms
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.
Assists in resolving elevated provider service complaints; researching and negotiating 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
Coach and support newer team members on strategies and approaches to successful negotiations
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; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity

Requirements

Must have current Georgia hospital contracting experience
Bachelor’s degree or equivalent experience in related field, including 7+ years of work experience beyond degree within provider contracting and/or health insurance
Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
Experience with complex Hospital / Health Systems, Large Physician Groups and Ancillary provider 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

Required profile