Provider Contracting Manager
Duties include negotiation/renegotiation of hospital, provider and ancillary agreements in accordance with The 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.
Develop and manage relationships and provide support service to assigned hospitals and key provider groups/facilities.
- B.S. Degree or equivalent work experience with a minimum of 5 years experience to include demonstrated, successful provider contract negotiations;
- Negotiating direct agreements for all provider types (Hospital, Ancillary and Physician) to meet Corporate objectives and goals;
- Attention to detail and commitment to excellence;
- Ability to troubleshoot, problem solve and work as part of a team or independently;
- Ability to use programs including Word, Excel and Outlook;
- Strong written and oral communication skills;
- Experience with hospital, physician and ancillary provider business models;
- Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position;
- Ability to prioritize multiple negotiations with continued follow up to resolution;
- Demonstrates high level of integrity, discretion and sound judgement when handling confidential information;
- Highly organized and focused.
- Knowledge of provider contract and payment concepts to include value based contracting and alternative payment models;
- Demonstrated history of maintaining good relationships with provider groups;
- Experience contracting with providers for government programs (Medicare, Medicaid, CHIP, etc.);
- Existing WV/Ohio provider relationships.