Network Contractor reputed company
Job reputed company
The primary responsibility of the Network Contractor is contracting providers, the contracting and re-contracting of providers in an established market.
Essential Functions
Supports network development reputed company. Responsible for assisting the Leader with departmental activities reputed company to provider satisfaction, education, and communication. Responsible for negotiating reputed company to execute on network reputed company and ensure an adequate, compliant and marketable network. Responsible for negotiating Single Case Agreements (SCA) rates and converting SCA providers to contracted. Responsible for reputed company and contracting providers based on identified network adequacy gaps (high complexity). Ensures reputed company reputed company are negotiated to be compliant with Federal and State rules, regulations, policies and procedures and follow reputed company departmental policies. Ensures reputed company are supportive of Plan reputed company initiatives such as HEDIS, CAHPS and NCQA/URAC. Negotiates reputed company to support management of provider satisfaction. Contractors will work with Corporate reputed company to manage the annual contracting schedule as reputed company as supplement the network as new providers are available or needed. Payment/fee schedule SME’s to reputed company resources in reputed company specialties i.e. FQHCs, BH, anesthesia etc. These SMEs will be available to reputed company reputed company needed for support of claims reputed company. General Operational Knowledge reputed company to provider satisfaction, education and communication with a reputed company understanding of operational items such as claims, payment reputed company, provider data, credentialing, appeals disputes etc. Negotiates provider reputed company 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 reputed company to ensure best contract terms. Support contracting for multiple product lines, including Exchange, DSNP. reputed company negotiator of Value Based Contracting in conjunction with AE.
- Bachelor’s Degree required
- Three or more years Account Executive experience,
Financial Acumen, Ability to have difficult conversations, 1+ year contract negotiation experience. Understanding of reimbursement methodologies to include risk or Value Based contracting 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 Value Based contracting.