This position is responsible for identifying and evaluating opportunities, negotiating optimal reimbursement rates, and drafting contracts for an assigned provider network to ensure patient access to the highest quality, cost-effective providers of healthcare services in accordance with applicable regulations and the Company's policies, practices and procedures.
JOB ROLES AND RESPONSIBILITIES:
1. Assist management in the identification and development of contracting priorities for assigned territory to support Network Development contracting initiatives.
2. Negotiate provider contracts to support penetration and discount objectives relative to competitive market tends and client expectations through comprehensive, aggressive execution of region specific contracting goals derived from national and regional objectives related to penetration and discount objectives, and improved contractual terms.
3. Foster and maintain superior provider relationships.
4. May assist in managing relationships with leased networks.
5. Maintain, and preferably exceed, contracting production and quality standards consistent with established national and regional goals.
6. Prepare analyses, reports and presentations by collecting, analyzing, and summarizing information and trends.
7. Partner with HCE to conduct financial analyses and monitoring of market trends to identify, develop, and implement competitive reimbursement.
8. May serve as mentor to less experienced Provider Contractors through on-going instruction, coaching, modeling, and counseling aimed at developing the type of skills and behaviors that will result in successful resolution of provider contracting. Share provider contracting insights and information with less experienced contractors.
9. Work with Regional Sales and Account Management to respond to and anticipate access requirements and network related performance guarantees. Use information derived from Requests for Proposals (RFP) to assess network adequacy and competitiveness in region.
10. Comply with mandatory training programs requirements, including Human Resources, product orientation and contracting tools and resources.
11. Ensure compliance with established policies and procedures, regulatory requirements, and mandatory training requirements (such as but not limited to HIPAA, integrity, product orientation, and contracting tools/resources).
12. Collaborate, coordinate, and communicate across disciplines and departments.
13. Demonstrate Company's Core Competencies and values held within.
14. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
The incumbent is considered to be a fully competent professional who knows and applies a broad knowledge of principles, practices, and procedures related to the negotiation and maintenance of provider network contracts. Evaluation, originality, and/or ingenuity are required to complete job responsibilities. Customer interface is primarily face-to-face/in-person, however a portion of interface could be telephonic. An incumbent works independently and has general latitude and discretion to make commitments with occasional need to confer with their supervisor to obtain guidance on the preferred approach to resolution of situations outside the standardized procedures. Incumbent understands when to escalate a contract issue to the next higher level and ensures that decisions consider the full implications (business, legal, and competitive) to both the Company and the customer. This position does not directly manage others, but provides mentorship as well as project or work direction to less experienced Provider Contractors who may be assigned to work with them on a project or team basis. The job may require overnight travel to meet with providers in assigned geographical or areas of responsibility. The incumbent will possess the skills necessary to strategize, construct and negotiate complex rate structures and contract language, and can demonstrate successful negotiations that require this skill set.