Responsible for facility, ancillary, physician, group, and/or behavioral health network development, contracting, credentialing, relationships, and services.
Guides and manages select functions of the network team. Acts as a leader and liaison between the health plan and network providers and/or with Mental Health facilities and physicians. Negotiates, develops, executes, and reviews contracts. Negotiates and oversees implementation of hospital and ancillary contracts. Prepares reports, completes an impact and trend analysis or utilization and cost data analysis and presents findings / creates action plans. Responsible for maintaining documentation for all institutional contracts and assisting with providing information for audits. Negotiates fees for out-of-network requests from other departments and monitors payments. Responsible for complex problem resolution. Acts as a liaison between internal departments. May manage the data flow for the provider entry and contracting process for physicians, ancillaries, and hospitals. *LI-CY
Minimum Requirements Bachelor’s degree; At least seven years’ experience in contracting for managed care and/or integrated provider systems. Strong presentation, negotiation, presentation, relationship building and communication skills. Proficient at Microsoft Office products and learning reporting applications.
Preferred Requirements: Master’s degree. Knowledge of contracting process, Medicare fee schedules, financial terms, and unit cost budgeting.
HealthSpring, Inc. is an EEO/AA employer.
HealthSpring - 2 years ago
Looking to keep a spring in Grandma's step, HealthSpring provides Medicare Advantage plans and Medicare Part D prescription drug...