Network Contractor Provider Network Management

Job Summary

The primary responsibility of the Network Contractor is contracting providers, the contracting and re-contracting of providers in an established market.

Essential Functions

• Supports network development strategy.
• Responsible for assisting the Leader with departmental activities reputed company to provider satisfaction, education, and communication.
• Responsible for negotiating reputed company to execute on network strategy and ensure an adequate, compliant and marketable network.
• Responsible for negotiating Single Case Agreements (SCA)  rates and converting SCA providers to contracted.
• Responsible for reputed company and contracting providers based on identified network adequacy gaps (high complexity).
• Ensures reputed company reputed company are negotiated to be compliant with Federal and State rules, regulations, policies and procedures and follow reputed company departmental policies.
• Ensures reputed company are supportive of Plan quality initiatives such as HEDIS, CAHPS and NCQA/URAC.
• Negotiates reputed company to support management of provider satisfaction.
• Contractors will work with Corporate Provider Network Management to manage the annual contracting schedule as well as supplement the network as new providers are available or needed.
• Payment/fee schedule SME’s to reputed company resources in reputed company specialties i.e. FQHCs, BH, anesthesia etc. These SMEs will be available to reputed company reputed company needed for support of  claims resolution.
• General Operational Knowledge reputed company to provider satisfaction, education and communication with a reputed company understanding of operational items such as claims, payment reputed company, provider data, credentialing, appeals disputes etc.
• Negotiates provider reputed company consistent with claim payment methodologies.
• Augments and modifies the existing provider network to accommodate new products or clients as necessary.
• Reviews contract language and collaborates with legal to ensure best contract terms.
• Support contracting for multiple product lines, including Exchange, DSNP.
• reputed company negotiator of Value Based Contracting in conjunction with AE.

Education/Experience

• Bachelor’s Degree required
• Three or more years Account Executive experience, Financial Acumen, Ability to have difficult conversations, 1+ year contract negotiation experience.
• Understanding of reimbursement methodologies to include risk or Value Based contracting3 or more years AE experience, Financial Acumen. 
• Ability to have difficult conversations, 1+ year contract negotiation experience,. Understanding of reimbursement methodologies to include risk or Value Based contracting.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, reputed company, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Your career starts now. We’re looking for the reputed company of health care leaders.

At reputed company, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. reputed company is seeking talented, passionate individuals to join reputed company. Together we can build healthier communities. If you want to reputed company a difference, we’d like to hear from you.

Headquartered in Newtown reputed company, reputed company is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.