Duties And Responsibilities

• Manages contract negotiations with physicians and physician groups in assigned area.
• Conducting several negotiations simultaneously to meet growth demands.
• Proactively builds relationships that nurture provider partnerships to support the local market strategy.
• Initiates, nurtures and maintains effective channels of communication with matrix partners including but not limited to, Claims, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing.
• Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position.
• Identify and manage initiatives that improve total medical cost and quality.
• Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.
• Assists in resolving elevated provider service complaints. Research problems and negotiate with internal/external partners/customers to resolve complex and/or escalated issues.
• Manages key provider relationships and is accountable for critical interface with providers and business staff.
• Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
• Partner with Regulatory Affairs to ensure all network filings are timely and accurate.
• Performs other duties as assigned

 

Position Requirements

• Bachelor’s degree or equivalent experience in related field, plus 3+ years of work experience within provider contracting and/or health insurance
• Experience with physician and physician group contracting and negotiations
• Experience negotiating delegated credentialing agreements
• Experience in developing and managing key provider relationships including senior executives
• Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
• Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models
• Team player with proven ability to develop strong working relationships within a fast-paced organization
• The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations
• Customer centric and interpersonal skills are required
• Superior problem solving, decision-making, negotiating skills, contract
• language and financial acumen
• Remote with occasional travel (5-10%)
• Existing relationships with physicians and physician groups in Texas is highly recommended