Network Contractor Provider Network Management

AmeriHealth Caritas

Charleston, SC(remote)

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JOB DETAILS

SKILLS

Administrative Skills, Anesthesiology, Behavioral Health, Biotech and Pharmaceutical, Broadband, Compensation and Benefits, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Contract Management, Contract Negotiation, Contract Review, Customer Support/Service, Federal Laws and Regulations, Fee Schedule, Healthcare, Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Providers, Legal, Managed Care, Microsoft Exchange Server, Microsoft Visual Basic, National Committee for Quality Assurance (NCQA), Negotiation Skills, Network Support, Pharmacy, Product Management, Provider Contracting, Provider Credentialing, Quality Assurance, Reimbursement, Risk, State Laws and Regulations, Strategic Planning, Utilization Review Accreditation Commission (URAC)

LOCATION

Charleston, SC

POSTED

4 days ago

Work Arrangement:

This position is a remote field based position. Must reside in South Carolina. Will make provider visits throughout the state.

Job Summary

The primary responsibility of the Network Contractor is contractingproviders, the contracting and re-contracting of providers in an established market.

Essential Functions:

+ Supports network development strategy.

+ Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication.

+ Responsible for negotiating contracts to execute on network strategy and ensure an adequate, compliant and marketable network.

+ Responsible for negotiating SCA rates and converting SCA providers to contracted.

+ Responsible for recruiting and contracting providers based on identified network adequacy gaps (high complexity).

+ Ensures all contracts are negotiated to be compliant with Federal and State rules, regulations, policies and procedures and follow all departmental policies.

+ Ensures contracts are supportive of Plan quality initiatives such as HEDIS, CAHPS and NCQA/URAC.

+ Negotiates contracts to support management of provider satisfaction.

+ Contractors will work with CPNM to manage the annual contracting schedule as well as supplement the network as new providers are available or needed.

+ Payment/fee schedule SME’s to develop resources in complex specialties i.e. FQHCs, BH, anesthesia etc. These SMEs will be available to AEs when needed for support of claims resolution.

+ General Operational Knowledge related to provider satisfaction, education and communication with a fundamental understanding of operational items such as claims, payment integrity, provider data, credentialing, appeals disputes etc.

+ Negotiates provider contracts consistent with claim payment methodologies.

+ Augments and modifies the existing provider network to accommodate new products or clients as necessary.

+ Reviews contract language and collaborates with legal to ensure best contract terms.

+ Support contracting for multiple product lines, including LTSS, Exchange, DSNP.

+ Lead negotiator of VBC in conjunction with AE.

Education/Experience:

+ Bachelor's Degree. Five or more years’ experience if no Bachelor’s Degree. Five or more years’ experience if no Bachelor’s Degree. Five or more years’ experience if no Bachelor’s Degree

+ 5 or more years experience if no Bachelor's Degree.

+ 3 or more years AE experience, Financial Acumen, Ability to have difficult conversations, 1+ year contract negotiation experience, Understanding of reimbursement methodologies to include risk or VB contracting.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com .

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

About the Company

AmeriHealth Caritas

Leaders in health care solutions for those most in need

AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than 5.7 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing innovative solutions that help improve health outcomes while reducing costs.

Our mission, our goal

Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.

COMPANY SIZE

5,000 to 9,999 employees

INDUSTRY

Healthcare Services

FOUNDED

1985

WEBSITE

http://www.amerihealthcaritas.com