Remote 
Provider Contract Specialist (Medicare Advantage/Managed Medicaid)
 MultiPlan | |
 United States | |
 Oct 05, 2024 | |
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JOB SUMMARY:
This position is responsible for identifying and evaluating opportunities, negotiating optimal reimbursement rates, and drafting contracts for an assigned provider network to ensure patient access to the highest quality, cost-effective providers of healthcare services in accordance with applicable regulations and the Company's policies, practices and procedures. JOB ROLES AND RESPONSIBILITIES: 1.Negotiate provider contracts to support penetration and discount objectives relative to competitive market tends and client expectations through comprehensive, aggressive execution of region specific contracting goals derived from national and regional objectives related to penetration and discount objectives, and improved contractual terms. 2.Foster and maintain superior provider relationships. 3.Maintain, and preferably exceed, contracting production and quality standards consistent with established regional goals. 4.Prepare analyses, reports and presentations by collecting, analyzing, and summarizing information and trends. 5.Partner with HCE to conduct financial analyses and monitoring of market trends to identify, develop, and implement competitive reimbursement. 6.Work with Regional Sales and Accounts Management Peers to respond to and anticipate access requirements and network related performance guarantees. Use information derived from Requests for Proposals (RFP) to assess network adequacy and competitiveness in region. 7.Comply with mandatory training programs requirements, including Human Resources, product orientation and contracting tools and resources. 8.Ensure compliance with established policies and procedures and with regulatory requirements (such as but not limited to HIPAA, integrity, product orientation, and contracting tools/resources). 9.Collaborate, coordinate, and communicate across disciplines and departments. 10.Demonstrate Company's Core Competencies and values held within. 11.The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary. JOB SCOPE: The incumbent works under general supervision in applying a fundamental knowledge of principles, practices, and procedures related to the negotiation and maintenance of provider network contracts. This job is considered to be the entry level job into the Provider Contractor job family. An incumbent follows established procedures and confers with their supervisor to obtain approval and authorization to act outside the standardized procedures. Minimal latitude exists for unreviewed action or discretion. More complex issues are referred to their supervisor for resolution. The work is varied and may be somewhat difficult in character and nature but usually involves limited responsibility. Some evaluation, originality, and/or ingenuity may be required. An incumbent may be called on to work with more experienced Provider Contractors on a project or team basis. The job may require overnight travel to meet with providers in assigned geographical or areas of responsibility and/or travel to company sponsored meetings and events. The incumbent will work to develop the skills necessary to strategize construct and negotiate complex financial rate structures and contract language, and can demonstrate successful negotiations that require this skill set. | |