Coordinate, negotiate and handle activities of the provider contracting, network development and/or provider relations functions and aid in formulating and administering organizational policies and procedures. Negotiate large hospital, physician groups and ancillary service agreements in accordance with Corporate, health plan and government regulations and guidelines.
Bachelor's degree in business administration, health care administration, related field or equivalent experience. 5–7 years of related experience negotiating hospital, large physician groups and ancillary service agreements and external customer service for providers. Experience in marketing/sales, medical economics in a managed care or insurance environment. Experience in provider network management, Medicaid/Medicare contracting, and/or claims processing preferred.
Licenses/Certifications: Current state driver’s license.
•Oversee provider contracting activities to ensure efficiency and maintain compliance with Company policies and standards, government laws and regulations
•Negotiate contracts with hospitals, physician groups and ancillary service agreements
•Develop and implement a network development plan for the assigned region and set of providers and identify and initiate contact with potential providers in support of the Company’s strategic goals and objectives
•Effectively integrate new programs and strategies to reach per member per month targets, and provide oversight to the provider set-up and contract configuration in the computer system to ensure accurate claims adjudication
•Perform basic financial analyses to identify medical cost improvement opportunities, develop strategies to reach financial goals, and execute contracting strategies to meet goals and objectives
•Evaluate and monitor providers’ performance standards and financial performance of contracts
Centene Corporation - 2 years ago
Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...