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Job A* Minimum
Recruits providers to join networks and supports or conducts standard contracting discussions with solo or small provider groups and implementations in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality, and financial goals.
Recruits providers in support of network management and expansion initiatives and coordinates standard contract and implementation documentation and discussions.
Provides support for network development, maintenance, and refinement activities including contract migration.
Partners across the organization to ensure all aspects of operational implementations are completed in a timely and accurate manner.
May assist with or support contracting activities and discussions for solo providers or small provider groups which involve negotiations.
Analyzes market data and orchestrates solicitation mailings to desired expansion targets.
May conduct or assist with service activities such as provider education, technology usage, or process updates.
Bachelor's degree desired or equivalent combination of education and work experience.
Knowledge of basic negotiating skills desired.
Proven working knowledge of standard provider contracts, terms and language desired.
0-3 years related experience
Job B * Preferred Candidate
Negotiates and executes contracts with solo, small group, or local providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality, and financial goals and cost initiatives.
Negotiates and executes contracts with solo, small group, or local providers. Manages contract performance and supports value based contracting and/or neighborhood network contracting in support of network quality, availability, and financial goals and strategies. Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities.
Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit. Assists with the design, development, management, and or implementation of strategic network configurations, including integration activities
May optimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
Bachelor's degree or equivalent combination of education and work experience
Strong communication, critical thinking, and interpersonal skills
Proven and proficient negotiating skills
Proven working knowledge of competitor strategies, complex contracting options, value based contracting, financial/contracting arrangements and regulatory requirements
3-5 years related experience
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