Provider Contracting Network Rep

Apply for the Provider Contracting Network Rep role at Care Plus Health Plans
.

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

$65,000.00/yr - $88,600.00/yr

The Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance.

• Actively communicates contract terms, payment structures, reimbursement rates to providers internal and external constituents
• Negotiating and maintaining contracts with hospital partners to ensure our network meets regulatory and business requirements.
• Managing relationships with key providers to support member access, minimize disruption, and maintain competitive advantage.
• Ensuring contract terms are implemented accurately and that our organization is protected from risk, both financially and legally.
• Supporting cross-functional teams with timely updates on contracting status, rate changes, and network developments.
• Managing these contract relationships with large statewide hospital systems requires the team to work with internal and external constituents on all areas of contracting; network management; adequacy and gaps; provider education; conflict resolution; claim escalation and research; compliance initiatives and grievances; joint operating committees; and all other facets of the business while also working closely with our Humana counterparts on enterprise initiatives.

• 2 or more years of experience in negotiating managed care contracts with physician specialty, hospital and/or other provider contracts.
• Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
• Experience with public speaking and presentation skills

• Bachelor's degree
• Experience with ACO/Risk Contracting
• Experience with Value Based Contracting
• Excellent written and verbal communication skills
• Ability to manage multiple priorities in a fast-paced environment
• Proficiency in MS Office applications

• Travel to Provider facing meetings as needed based on business needs
• Hours – 8am to 5pm EST

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.

If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in an SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes.

Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

To ensure Home or Hybrid Home/Office Associates’ Ability To Work Effectively, the Self-provided Internet Service Of Home or Hybrid Home/Office Associates Must Meet The Following Criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking…