DescriptionThe Provider Contracting Professional 2 initiates, negotiates, and executes LTC provider contracts and agreements for an organization that provides LTC health insurance. The Provider Contracting Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Network relationship management, including, but not limited to: Quality, Payment, Provider Experience, Financial Performance, Industry Trends, Legislative changes, AHCA contract requirements. implement and execute Network initiatives and strategic goals for network adequacy, contracting payment initiatives and AHCA compliance. Identify and support new trends and savings opportunities related to network. Oversight of provider education/training, ensure trainings support provider needs and required by new AHCA contract. Build and support provider association relationships. Work with clinical leaders to address concerns and ensure enrollees have appropriate access to providers.
The Provider Contracting Professional 2 communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms. Understands alternate payment structures and quality incentives for LTC providers. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
- 3+ years of experience in negotiating managed care contracts with LTC provider contracts.
- 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
- Bachelor's degree or equivalent
- Experience with report validation and interpretation
- Experience with Value Based Contracting
- Bilingual - English/Spanish
Scheduled Weekly Hours40