The Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Provider Contracting Professional 2 communicates contract terms, payment structures, and reimbursement rates to providers within the Behavioral Health/Medicaid space. You will develop and grow positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
* Bachelor’s degree
* 2 – 5 years of experience in negotiating managed care contracts with physician, hospital and/or other provider contracts.
* 1+ years experience with Medicaid contracting
* Experience in provider engagement and education
* Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
* Excellent written and verbal communication skills
* Ability to manage multiple priorities in a fast-paced environment
* Proficiency in MS Office applications
* Must be passionate about contributing to an organization focused on continuously improving consumer experiences
* Master’s Degree
* Experience with Value Based Contracting
* Experience working with Behavioral Health Medicaid contracts
This position will be remote/work at home, to be based anywhere in the United States
Scheduled Weekly Hours