Senior Provider Contracting Professional - AZ, LA, MS Markets

Centerwell, Limited Partnership - Springfield, IL

Full-time - Mid Level

Springfield, IL

Real Estate

About the position

The Senior Provider Contracting Professional plays a crucial role in negotiating and executing provider contracts for a health insurance organization. This position involves working closely with market engagement teams and legal partners to ensure contract compliance and drive growth in the AZ, LA, and MS markets. The role requires a deep understanding of financial impacts related to contracts and the ability to communicate effectively with provider groups.

Responsibilities

• Partner closely with AZ, LA, and MS market engagement and leadership teams to support contract execution and drive towards growth goals.
• Engage with legal team business partners to review and address contract term revisions.
• Communicate contract terms, payment structures, and reimbursement rates to IPA and ACO provider groups.
• Analyze financial impact of contracts and terms.
• Maintain contracts and documentation within a tracking system.
• Manage the relationship between market payor partners and PCO market leadership.
• Assist with new contracts and amendments with market payors due to changes in market needs or potential mergers and acquisitions.
• Handle contract load and implementation with payor partners.
• Assist in identifying and recruiting providers based on network composition and needs within the IPA/ACO markets.
• Begin to influence department's strategy.
• Make decisions on moderately complex to complex issues regarding technical approach for project components.

Requirements

• Bachelor's degree or five years equivalent experience.
• A minimum of five years of progressive network management experience including hospital contracting and network administration in a healthcare company.
• Experience with Value Based Contracting.
• Managing and implementing care contracts with large physician groups, ancillary providers, and hospital systems.
• Proficiency in analyzing, understanding, and communicating financial impact of contract terms, payment structures, and reimbursement rates to providers.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency in MS Office applications.
• Passion for contributing to an organization focused on continuously improving consumer experiences.

Nice-to-haves

• Experience with MSO