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Job Requirements of Provider Contract Specialist (Medicare Advantage/Managed Medicaid):
JOB REQUIREMENTS (Education, Experience, and Training):
• Minimum Bachelor’s Degree in related or applicable field, or HS Diploma (or GED) and four (4) years’ experience related to network development
• Minimum 1 year experience in provider contracting and network development, or equivalent provider/payer experience, successfully negotiating rate and contract language
• Required licensures, professional certifications, and/or Board certifications as applicable
• Knowledge and understanding of provider finance components including budget, charge structure, reimbursement formulas and healthcare finance
• Knowledge of provider organizations and operations applicable to assigned focus
• Communication (written, verbal and listening), analytical, negotiation, business acumen, organization, strategic, multitasking and prioritization skills
• Ability to demonstrate successful negotiations by developing skills necessary to strategize, construct, and negotiate complex financial rate structures and contract language
• Ability to successfully manage multiple competing priorities.
• Ability to elicit trust and credibility with all levels of the organization
• Ability to effectively communicate the MultiPlan Value Proposition.
• Ability to work comfortably and routinely as part of a team and to cooperate across organizational boundaries
• Ability to build relationships with internal and external customers
• Ability to use computer software, hardware, and peripherals applicable to role
• Up to 50% travel within assigned region, primarily to meet with providers on a frequent basis and, at times, with little advance notice, as well as travel to attend MultiPlan sponsored meetings and appropriate professional conferences
COMPENSATION
The salary range for this position is $50,000/year. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.
BENEFITS
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
- Medical, dental and vision coverage with low deductible & copay
- Life insurance
- Short and long-term disability
- 401(k) + match
- Generous Paid Time Off
- Paid company holidays
- Paid Parental Leave
- Tuition reimbursement
- Flexible Spending Account
- Employee Assistance Program
- Summer Hours
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.
Do you meet the requirements for this job?
Provider Contract Specialist (Medicare Advantage/Managed Medicaid)
This position is responsible for identifying and evaluating opportunities, negotiating optimal reimbursement rates, and drafting contracts for an assigned provider network to ensure patient access to the highest quality, cost-effective providers of healthcare services in accordance with applicable regulations and the Company’s policies, practices and procedures
JOB ROLES AND RESPONSIBILITIES:
1. Negotiate provider contracts to support penetration and discount objectives relative to competitive market tends and client expectations through comprehensive, aggressive execution of region specific contracting goals derived from national and regional objectives related to penetration and discount objectives, and improved contractual terms.
2. Foster and maintain superior provider relationships.
3. Maintain, and preferably exceed, contracting production and quality standards consistent with established regional goals.
4. Prepare analyses, reports and presentations by collecting, analyzing, and summarizing information and trends.
5. Partner with HCE to conduct financial analyses and monitoring of market trends to identify, develop, and implement competitive reimbursement.
6. Work with Regional Sales and Accounts Management Peers to respond to and anticipate access requirements and network related performance guarantees
Use information derived from Requests for Proposals (RFP) to assess network adequacy and competitiveness in region.
7. Comply with mandatory training programs requirements, including Human Resources, product orientation and contracting tools and resources.
8. Ensure compliance with established policies and procedures and with regulatory requirements (such as but not limited to HIPAA, integrity, product orientation, and contracting tools/resources).
9. Collaborate, coordinate, and communicate across disciplines and departments.
10. Demonstrate Company’s Core Competencies and values held within.
11. The position responsibilities outlined above are in no way to be construed as all encompassing
Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
JOB SCOPE:
The incumbent works under general supervision in applying a fundamental knowledge of principles, practices, and procedures related to the negotiation and maintenance of provider network contracts
This job is considered to be the entry level job into the Provider Contractor job family
An incumbent follows established procedures and confers with their supervisor to obtain approval and authorization to act outside the standardized procedures
Minimal latitude exists for unreviewed action or discretion
More complex issues are referred to their supervisor for resolution
The work is varied and may be somewhat difficult in character and nature but usually involves limited responsibility
Some evaluation, originality, and/or ingenuity may be required
An incumbent may be called on to work with more experienced Provider Contractors on a project or team basis
The job may require overnight travel to meet with providers in assigned geographical or areas of responsibility and/or travel to company sponsored meetings and events
The incumbent will work to develop the skills necessary to strategize construct and negotiate complex financial rate structures and contract language, and can demonstrate successful negotiations that require this skill set.
Job Requirements:
JOB REQUIREMENTS (Education, Experience, and Training):
• Minimum Bachelor’s Degree in related or applicable field, or HS Diploma (or GED) and four (4) years’ experience related to network development
• Minimum 1 year experience in provider contracting and network development, or equivalent provider/payer experience, successfully negotiating rate and contract language
• Required licensures, professional certifications, and/or Board certifications as applicable
• Knowledge and understanding of provider finance components including budget, charge structure, reimbursement formulas and healthcare finance
• Knowledge of provider organizations and operations applicable to assigned focus
• Communication (written, verbal and listening), analytical, negotiation, business acumen, organization, strategic, multitasking and prioritization skills
• Ability to demonstrate successful negotiations by developing skills necessary to strategize, construct, and negotiate complex financial rate structures and contract language
• Ability to successfully manage multiple competing priorities.
• Ability to elicit trust and credibility with all levels of the organization
• Ability to effectively communicate the MultiPlan Value Proposition.
• Ability to work comfortably and routinely as part of a team and to cooperate across organizational boundaries
• Ability to build relationships with internal and external customers
• Ability to use computer software, hardware, and peripherals applicable to role
• Up to 50% travel within assigned region, primarily to meet with providers on a frequent basis and, at times, with little advance notice, as well as travel to attend MultiPlan sponsored meetings and appropriate professional conferences
COMPENSATION
The salary range for this position is $50,000/year. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.
BENEFITS
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
- Medical, dental and vision coverage with low deductible & copay
- Life insurance
- Short and long-term disability
- 401(k) + match
- Generous Paid Time Off
- Paid company holidays
- Paid Parental Leave
- Tuition reimbursement
- Flexible Spending Account
- Employee Assistance Program
- Summer Hours
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.