Curative HR LLC
Senior Network Contracting Specialist
Curative HR LLC, Austin, Texas, us, 78716
Responsibilities
Manages contract negotiations with large physician groups and ancillary providers; conducting several negotiations simultaneously to meet growth demandsDeep understanding and experience with all clinical specialties to ensure contract terms and conditions address the coding structures which are most impacted by negotiationsProactively builds relationships that nurture provider partnerships to support the local market strategyInitiates, nurtures, and maintains effective channels of communication with matrix partners including but not limited to, Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and MarketingResponsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive positionIdentify and manages initiatives that improve total medical cost and quality; including renegotiation of existing agreementsPrepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract termsCollaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities.Assists in resolving elevated provider service complaints; researching and negotiating with internal/external partners/customers to resolve complex and/or escalated issues.Manages key provider relationships and is accountable for critical interface with providers and business staffCoach and support new team members on negotiation strategies and approaches to successfulDemonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscapePartner with Regulatory Affairs to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health ParityPosition Requirements
Bachelor's degree or equivalent experience in related field, including 7+ years of work experience beyond degree within provider contracting and/or health insuranceRemote with occasional travel (5-10%)Existing relationships with ancillary providers and large physician groups in Texas7+ years of experience with health plan or provider organizationsSuperior problem solving, decision-making, negotiating skills, contract language and financial acumenExperience with Physician group and ancillary provider contracting and negotiationsExperience negotiating delegated credentialing agreementsExperience in developing and managing key provider relationships including senior executivesDemonstrated experience in seeking out, building and nurturing strong external relationships with provider partnersIntimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business modelsTeam player with proven ability to develop strong working relationships within a fast-paced organizationThe ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentationsCustomer centric and interpersonal skills are required
Manages contract negotiations with large physician groups and ancillary providers; conducting several negotiations simultaneously to meet growth demandsDeep understanding and experience with all clinical specialties to ensure contract terms and conditions address the coding structures which are most impacted by negotiationsProactively builds relationships that nurture provider partnerships to support the local market strategyInitiates, nurtures, and maintains effective channels of communication with matrix partners including but not limited to, Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and MarketingResponsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive positionIdentify and manages initiatives that improve total medical cost and quality; including renegotiation of existing agreementsPrepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract termsCollaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities.Assists in resolving elevated provider service complaints; researching and negotiating with internal/external partners/customers to resolve complex and/or escalated issues.Manages key provider relationships and is accountable for critical interface with providers and business staffCoach and support new team members on negotiation strategies and approaches to successfulDemonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscapePartner with Regulatory Affairs to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health ParityPosition Requirements
Bachelor's degree or equivalent experience in related field, including 7+ years of work experience beyond degree within provider contracting and/or health insuranceRemote with occasional travel (5-10%)Existing relationships with ancillary providers and large physician groups in Texas7+ years of experience with health plan or provider organizationsSuperior problem solving, decision-making, negotiating skills, contract language and financial acumenExperience with Physician group and ancillary provider contracting and negotiationsExperience negotiating delegated credentialing agreementsExperience in developing and managing key provider relationships including senior executivesDemonstrated experience in seeking out, building and nurturing strong external relationships with provider partnersIntimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business modelsTeam player with proven ability to develop strong working relationships within a fast-paced organizationThe ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentationsCustomer centric and interpersonal skills are required