Performs duties to coordinate and negotiate hospital, physician and ancillary service agreements that are in accordance with Corporate Health Plan, State, and Federal guidelines in order to maintain and enhance the provider network and to meet/exceed The Health Plan's accessibility, quality and financial goals.
Maintain close relationships with Hospitals and key provider groups.
- Four (4) year college degree in healthcare administration, business administration, marketing or related field and three (3) years managed care industry experience.
- Knowledge of contracting/sales, provider customer service, standard credentialing procedures and/or marketing.
- Knowledge of contracting language, the principles of negotiation and the ability to understand different types of reimbursement models.
- Experience in healthcare or insurance environment.
- Must be able to apply corporate policies and procedures to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
- Interpret a variety of instructions in written, oral or diagrammatic form.
- Ability to negotiate effectively.
- Ability to use programs including Word, Excel and Outlook.
- Superior written and oral communication skills.
- Ability to interpret and compose spreadsheets, reports and presentations.
- Strong analytical, problem solving and project management skills.
- Must be able to meet deadlines and work under pressure with little to no direct supervision.
- Knowledge of healthcare finance principals.
- Knowledge of healthcare quality initiatives.
- Knowledge of performance based contracting.
- Existing WV or OH healthcare relationships.