Job Title: Provider Contracting Spec
Posting Location: TX - San Antonio
Location: TX - San Antonio
Employment Status: Full Time
Job Requisition Number: 167259
Provider Contracting Specialist
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.
agreements for all contracts pertaining to fully insured, Health Plan, PPO,
- Responsible for research, analysis, and negotiation support of contract
corporate accounts, lease networks and workers' compensation.
communications with all physicians and other providers.
- Develops and implements a formal, documented ongoing program to ensure good
physician and hospital network
- Assists managers and staff in planning, recruiting and implementing the
contracts. Prepares and evaluates reports regarding the provider network.
- Assists managers and staff with the development and monitoring of provider
the accuracy of provider data entered into the provider database.
- Manages the addition and termination of providers into the network. Ensures
- Performs other duties as required.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we
- 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.
are committed to building a talented and diverse team.
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...