Job Snapshot
Location:
Salisbury, MD 21801
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Employee Type:
Contractor
Industry:
Healthcare - Health Services
Insurance
Manages Others:
Not Specified
Job Type:
Business Development
Health Care
Experience:
Not Specified
Contact Information
Description
The Provider Contracting Consultant is responsible for contracting with the appropriate vendors, ancillaries, physicians, hospitals, and other providers on Maryland's Eastern Shore to ensure adequacy of access is met for purposes of new market or product filings/applications, and for continued development after submission of filings/applications to ensure that the provider network is in a market competitive position. Works with standard contracting process to develop, negotiate and execute contracts or other documents as needed. This position requires extensive travel and the incumbent must be able to quickly learn and be adaptive to new, different and/or changing market conditions.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:
Works with data to develop and manage provider recruitment targets and project plans. Complies with standard policies and procedures in developing contract language and reimbursement methodologies to prepare, develop, and negotiate provider contracts. Uses Medical Economics’ financial modeling tools to assist in the provider negotiation process and to ensure that the financial risk of the Company is protected.
Coordinates analysis with Medical Economics, as appropriate.
KNOWLEDGE, SKILLS AND ABILITIES
Strong understanding of Medicare payment methodologies by provider type. Strong communication and influencing skills. Ability to work independently and often with minimal guidance Ability to balance multiple and changing priorities and consistently meet deadlines. Ability to analyze and make recommendations regarding supply and demand of a particular provider service within the market and negotiate recommendations. Ability to understand Managed care principles, as well as their application and implication on contract development and administration, such as Utilization Management, system configuration, and claims payment. Organized and comfortable managing an expense account and making travel arrangements.
EDUCATION
Bachelor’s degree or equivalent work experience; MBA preferred.
EXPERIENCE
At least 5 years of healthcare experience with at least 3 years specifically in Provider Relations, Provide contracting or purchasing, or managed healthcare Strong knowledge of the Managed Care Industry and clinical terminology Ability to travel extensively
COMPUTER SKILLS
MS Office Suite Experience with External Reporting Tools
PHYSICAL DEMANDS/WORK ENVIRONMENT
Current Driver’s License and Automobile required Ability to use a computer keyboard and view a monitor
