Van Alstyne, TX 75495
The ideal candidate has career experience and a skill set that will support and enable a strong understanding of provider network contracting strategy related to development and maintenance of market competitive provider agreements. Manage the provider contracting process from service delivery planning through implementation, including ongoing monitoring and evaluation. Act as lead negotiator for the Provider Relations/Delivery System team and write contract documents.
Acts as lead negotiator (e.g. proposal development & execution) for the Provider Relations/ Delivery System team in negotiations with community providers (e.g. hospitals, multi-specialty groups, large for-profit vendor organizations, skilled nursing facilities, etc.).
Authors the contract document and ensures the complete & appropriate implementation of contractual arrangements, in accordance with payment policy and business & system requirements.
Identifies, recommends and facilitates timely resolution of provider training & enhancement strategies to achieve maximum value from contracted relationships. Facilitates problem resolution strategies involving a variety of departments including Legal, Claims, Membership Patient Financial Services, Delivery System, Provider Services, etc.
Reviews and approves all contracted provider network information prior to publication/ marketing.
Conducts and/or oversees financial modeling and recommends financial terms meeting payment policy and divisional objectives of Delivery System leadership.
Provides knowledge, information, consultation and decision level recommendations to inform service delivery planning, provider selection and retention process. Serves as single point of contact between Provider Relations and accountable delivery system divisional management on a service line basis.
Advanced working knowledge of various reimbursement methodologies, including quality improvement and risk arrangement. Strong analytical skills related to medical expenses and utilization.
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1999-2004, Barcus Associates