Offer summary

Qualifications:

Bachelor’s degree or equivalent experience in a related field., 10+ years of work experience in provider contracting and/or health insurance., Superior problem-solving, decision-making, and negotiating skills., Experience with physician group contracting and credentialing..

Key responsabilities:

Manage the provider contracting process for a health plan.

Lead the implementation of process improvements and automation.

Collaborate with various departments to optimize the contracting process.

Establish and manage provider contract review policies and procedures.

Job description

Remote with occasional travel (5%)

10+ years of experience with health plan or provider organizations

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.

Lead the implementation of process improvements, including streamlining processes, adding automation and implementing new tools and vendor solutions.
Collaborate with network contracting colleagues, as well as legal department, compliance, credentialing and claim operations to optimize and streamline the entire 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 10+ 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 physician group and ancillary provider contracting language and reimbursement
Experience with credentialing
Experience improving provider data accuracy
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.

Required profile