Senior Provider Contracting Professional - AZ, LA, MS Markets

Centerwell, Limited Partnership - Augusta, ME

Full-time - Mid Level

Augusta, ME

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 addressing moderately complex to complex issues, requiring in-depth analysis and evaluation of various factors. The professional will collaborate with market engagement teams and legal partners to ensure effective contract management and support organizational growth goals.

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