Assists in network development and provider service functions for hospitals and selected ancillary providers within a state(s). Works with finance, legal, medical management, sales, provider operations and provider service center personnel in developing actions to meet market growth and medical cost targets and excellent provider customer service.
DEPARTMENT: Network Development
REPORTS TO: Sr. Director, Hospital Contracting
- Assists in developing a comprehensive network strategy to support market growth and medical cost targets.
- Assists Manager in preparation and execution of periodic contract escalators/amendments and changes related to Medicare or Medicaid.
- Ensures all contracts/amendments meet regulatory guidelines for all products.
- Assists in negotiating both financial and language terms of hospital contracts utilizing internal end-to-end process.
- Verifies contract terms and demographics are loaded correctly in company databases.
- Establishes effective departmental practices and work closely with various departments (finance, operations, legal, regulatory, sales, etc.) to ensure contracts meet operating, financial and legal standards.
- Ensures compliance with Medicaid and Medicare for all contracting and network development purposes.
- Performs provider education through in-service activities and regularly scheduled follow up with providers.
- Ensures that providers receive provider and hospital communications i.e. – letters, newsletters, training materials, etc. to educate and enhance relationships with providers.
- Creates and maintain strong relationships with internal and external contracts to support departmental goals.
- Works closely with the In-house Network Development staff regarding contracting questions.
- Performs contract administration including working with corporate on market specific templates, maintaining local files and documentation, ensuring LOA's are converted to contracts, and meeting GEOACCESS requirements for LOB's.
- Perform other duties as assigned.
- Assists in the recommendation of innovative contracting strategies to maximize cost containment, access and quality through provider arrangements
- Participates in Hospital Joint Operating Committee Meeting
- Bachelor's Degree in a related field
- 2 years of experience in the healthcare sector (preferably at HMO, PPO or hospital) with focus on HMO provider/hospital/ancillary contracting
- Demonstrated interpersonal/verbal communication skills
- Demonstrated written communication skills
- Demonstrated negotiation skills
- Demonstrated customer service skills
- Demonstrated analytical skills
- Ability to work in a fast paced environment with changing priorities
- Demonstrated organizational skills
- Ability to remain calm under pressure
- Ability to identify unusual variation in medical costs and to assess impact of change
- Knowledge of regulatory requirements concerning Medicare and Medicaid
- Microsoft Excel
- Microsoft Word
- Microsoft PowerPoint
- Microsoft Outlook