Senior Provider Network Contractor - 241988

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This range is provided by Medix. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

$45.00/hr - $55.00/hr

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A local non-profit health plan in Aurora, CO is looking for a HYBRID Senior Provider Network Contractor to join their team.

The Senior Provider Network Contractor is responsible for managing the full spectrum of provider relationships and the entire contracting process, to include analysis of contract proposals, recruitment of new providers, contract negotiations with existing providers, and execution and operational implementation and support.

Overview of Responsibilities:

• Negotiates complex provider agreements utilizing a variety of negotiation strategies and techniques with all provider types, with emphasis on developing strategic partnerships with facilities, health systems, integrated care delivery systems, physician hospital organizations, independent practice associations, individual providers and clinics, ancillary providers, FQHCs and other providers.
• Maintains proficiency in current and proposed reimbursement methodologies for facility and professional contracts, contract language and provisions and organizational operations to assure contract offers can be implemented and effectively administered.
• Provides comprehensive management of the contracting process, including rate and language negotiations, and operational implementation.
• Works with contracted providers on contract interpretation and assists with operational and/or reimbursement issue resolution.
• Provides financial and operational performance analysis of existing and pending Provider contracts.
• Provides guidance, support and direction to Managed Care Contractors and other department staff as needed.
• Serves as the project lead and subject matter expert for one or more of the following:
• Development and revision of multiple contract templates for contract management system, in collaboration with the Director, and software vendor
• Appropriate billing and coding for physical and behavioral health
• Serves as contract management system administrator as assigned
• Works with legal and other staff to resolve complex claims issues

Requirements:

• 5-8 years experience negotiating complex contracts with health care providers (ex: hospitals, health systems, medical groups, clinics)
• Experience with strategic planning; development, revision and quality control of contract templates, contracting guidelines; determination of network adequacy and capacity standards and other policies and procedures
• Analytical, reviewing claims history and trends
• Advanced knowledge of managed care contracting, provider reimbursement and claims payment, medical terminology, and health care delivery systems required.
• Must be proficient in MS-Office applications (Word, Excel, and Access).

Additional Skills:

• Experience with value-based contact arrangements

Schedule/Shift:

• M-F schedule options: 8am-5pm, 8:30am-5:30pm, or 9am-6pm
• This role will begin as fully remote, then will move to hybrid 2x per week

520 Hours. Opportunity to convert to permanent hire after satisfactory completion of contract.

Pay:

$45 - $55 (Dependent on experience)

401(k) Retirement Plan, Medical, dental and vision plans, Short Term Disability Insurance, Life Insurance Plan, Weekly Pay, Paid Sick Time

• Seniority level
  
  Mid-Senior level

• Employment type
  
  Full-time

• Job function Consulting
• Industries Hospitals and Health Care

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Medical insurance

Vision insurance

401(k)

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