Associate Network Contracting
Job Summary
The Associate, Network Contracting will manage contracts with key healthcare providers, including hospitals and national ancillary groups, to build a robust network. This role involves optimizing costs by analyzing provider performance, negotiating reimbursement rates, and ensuring compliance with regulatory guidelines. You will support national network strategy and work cross-functionally to provide best-in-class care for members.
Responsibilities
- Manage and negotiate provider contracts
- Analyze provider performance and reimbursement rates
- Ensure regulatory and network compliance
- Support national network strategy development
Required Skills
- 3+ years healthcare contracting/consulting experience
- 2+ years provider network strategy experience
- Financial analysis of markets and product lines
- Data analysis skills (claims and rosters)
Job Details
Responsibilities:
- Implement contracting strategies under the direction of Network Director and/or Senior Manager and in partnership with Market Leaders that align with the company's overall network adequacy, development and cost management objectives.
- Manage and negotiate contracts with assigned healthcare providers, focusing on favorable terms and compliance with organizational standards and regulatory requirements.
- Support comprehensive reviews and analyses of assigned provider contracts, identifying areas for improvement and optimization.
- Utilize data and analytics of provider financial issues and competitor strategies to support informing negotiation and contracting decisions.
- Meet defined metrics and SLAs including but not limited to provider outreach and contract completion.
- Collaborate with the provider services team regarding the servicing, education and communication to our provider network.
- Monitor assigned networks to gauge compliance with standards, developing corrective action plans with network contracting and market leadership to remediate deficiencies.
- Compliance with all applicable laws and regulations.
- Other duties as assigned.
Requirements:
- 3+ years of experience in healthcare client management, healthcare consulting, or provider healthcare contracting, healthcare operations, or a related field.
- 2+ years of experience supporting provider network strategy development and negotiating provider contracts.
- 1+ years experience running financial analyses on a markets or product lines, and working cross-functionally to support driving improvement opportunities.
- 1+ years experience navigating and organizing large data sets such as claim files and provider rosters.
- Bonus points: Associate's degree or equivalent professional working experience.