Offer summary

Qualifications:

Bachelor’s degree or equivalent experience in a related field., 3+ years of work experience in provider contracting and/or health insurance., Intimate understanding of managed care and provider business models., Strong communication skills and experience in building relationships with healthcare providers..

Key responsibilities:

Manage contract negotiations with health system providers and physician groups.

Build and maintain relationships to support local market strategy.

Prepare and analyze financial impacts of provider contracts.

Resolve provider service complaints and manage key provider relationships.

Job description

Duties And Responsibilities

Manages contract negotiations with health system providers (facility, ancillary, physician) and hospital based physician groups in assigned areas.
Conducting several negotiations simultaneously to meet growth demands.
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 manage initiatives that improve total medical cost and quality.
Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.
Assists in resolving elevated provider service complaints. Research problems and negotiate 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.
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.
Performs other duties as assigned

Position Requirements

Bachelor’s degree or equivalent experience in related field, plus 3+ years of work experience within provider contracting and/or health insurance
Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models
Experience with health system and hospital based physician group contracting and negotiations
Existing relationships with physicians and physician groups in Texas is highly recommended
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
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
Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
Remote with occasional travel (5%)
Existing relationships and experience with health system providers (facility, ancillary, physician), hospital based physician groups and ancillary providers in Texas is highly recommended

Required profile