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1 Week Ago
Senior Network Contracting Specialist
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$104k-136k (estimate)
Full Time 1 Week Ago
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Curative HR LLC is Hiring a Senior Network Contracting Specialist Near Austin, TX

Existing relationships with physician groups in Texas and/or Florida will be helpful
7 years of experience with health plan or provider organizations
Responsibilities
  • Manages contract negotiations with 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 new team members on negotiation strategies and approaches to successful
  • 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
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
  • Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
  • Experience with Physician group 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

Job Summary

JOB TYPE

Full Time

SALARY

$104k-136k (estimate)

POST DATE

05/01/2024

EXPIRATION DATE

05/20/2024

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