Responsible for initial contract negotiations and renewals with physicians, group practices, and ancillary providers; financial management and analysis of provider contracts; produce timely contracts within predetermined medical trend guidelines.
Bachelors Business healthcare or finance or A minimum of four (4) years experience in contracting, managed care, healthcare, provider office or legal setting may be a substitute for education requirements.
CERTIFICATION & LICENSURE REQUIREMENTS
Valid Driver's License and Proof of Auto Insurance
Two (2) years Related Field. Two (2) years experience in contracting, managed care, healthcare, provider office or legal setting.
Demonstrated proficiency in Word, Excel, and database software required. Must project a professional image while interacting with a variety of personalities in person, over the telephone or via electronic mail. Must have a general understanding of managed care and concepts. Must have exposure to legal documents and basic negotiation skills and a desire to enhance skills. Must be able to explain and justify legal documents and language. Ability to do both internal and external research related to provider status and reimbursements in order to prepare for network development and contracting.
Develops financial proposals, evaluates and monitors contract performance and prepares financial analysis and recommendations.
Ensures that all contracts are in compliance with regulatory requirements.
Manages overall contracting process with providers including preparation of documents, negotiation, follow-up, and documentation of activities in contract management system.
Plans proactively for all contract renewals including financial analysis and potential reimbursement changes; completes renewal process.
Ensures that all negotiated contract terms follow Health Alliance's standards and can be successfully implemented in the claims payment system. Ensures interpretation of the contract for operational needs. Responsible for auditing of claims system.
Full - Time