Provider Contracting Spec Job
Coventry Health Care - San Antonio, TX

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Job Title: Provider Contracting Spec

Posting Location: TX - San Antonio

Location: TX - San Antonio

Employment Status: Full Time

Job Requisition Number: 167259

External Description:
Provider Contracting Specialist

GENERAL SUMMARY
Assists with managed care contracting with physicians and ancillary providers
for all contracts pertaining to fully insured, Health Plan, PPO, corporate
accounts, lease networks and workers' compensation. Performs ongoing network
analysis. Recruits and contracts with individual providers who meet established
selection criteria to assure adequate geographic and specialty coverage. Makes
recommendations for retention or delistment of providers.

ESSENTIAL RESPONSIBILITIES
  • Responsible for research, analysis, and negotiation support of contract
agreements for all contracts pertaining to fully insured, Health Plan, PPO,
corporate accounts, lease networks and workers' compensation.
  • Develops and implements a formal, documented ongoing program to ensure good
communications with all physicians and other providers.
  • Assists managers and staff in planning, recruiting and implementing the
physician and hospital network
  • Assists managers and staff with the development and monitoring of provider
contracts. Prepares and evaluates reports regarding the provider network.
  • Manages the addition and termination of providers into the network. Ensures
the accuracy of provider data entered into the provider database.
  • Performs other duties as required.
JOB SPECIFICATIONS
  • Bachelor's degree or equivalent experience.
  • Previous (usually 3+ years) experience in provider contract negotiation.
  • Substantive knowledge of managed care policy and direction.
  • Knowledge of ICD-9 and CPT codes desired.
  • Strong analytic and problem solving abilities.
  • Strong communication and negotiation skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we
are committed to building a talented and diverse team.
CBC:02/06/2012

Coventry Health Care - 2 years ago - save job - block
About this company
339 reviews
In May of 2013, Coventry became a part of Aetna. We are excited to join together with common values and a common mission: empowering people...