Provider Network Manager Sr

$90,300 - $154,800/Yr

Elevance Health - New Hyde Park, NY

Full-time - Mid Level

New Hyde Park, NY

11-50 employees

Insurance Carriers and Related Activities

About the position

The position focuses on developing the provider network through contract negotiations, relationship development, and servicing. The primary responsibility is to negotiate complex contracts with various providers, including large medical groups and institutional providers. This role requires a high level of negotiation skills and critical thinking, as it involves non-standard arrangements and customized fee schedules.

Responsibilities

• Conducts more complex negotiations and drafts documents
• Prepares financial projections and conducts analysis
• Serves as a key resource for other contracting staff and provides mentoring and on-the-job training
• Works independently, requiring critical thinking and high levels of judgment and discretion
• Collaborates on projects impacting the business unit and serves on enterprise projects around network management
• Collaborates with the sales team in making presentations to employer groups
• Acts as a communication link between professional providers and the company
• Ensures network composition includes an appropriate distribution of provider specialties
• Develops and implements network strategies to maintain high quality and affordable healthcare for Anthem members

Requirements

• BA/BS degree
• Minimum of 5 years' experience in contracting, provider relations, or provider servicing
• Prior contracting experience

Nice-to-haves

• Experience in fee schedule development using actuarial models
• Experience in contract language negotiations
• Knowledge of Medicare, Medicaid, and Commercial reimbursement methodologies
• Proficiency with MS Office products (MS Word, MS Excel)

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid holidays
• Paid Time Off
• Medical, dental, vision benefits
• Short and long term disability benefits
• Life insurance
• Wellness programs
• Financial education resources