Provider Network Contractor

Academy of Managed Care Pharmacy; Aurora (CO); Hybrid; USD 77,000 - 95,000; Full time

Job summary

Ein innovatives Unternehmen sucht einen PROVIDER NETWORK CONTRACTOR, um die Vision und Mission zu unterstützen. Diese Rolle umfasst die Verhandlung von Verträgen mit Gesundheitsdienstleistern, die Pflege von Beziehungen und die Gewährleistung der Netzwerkangemessenheit. In einem hybriden Arbeitsumfeld haben Sie die Möglichkeit, einen bedeutenden Einfluss auf die Gesundheitsversorgung in der Gemeinschaft zu haben. Wenn Sie leidenschaftlich daran interessiert sind, die Gesundheitsversorgung für benachteiligte Bevölkerungsgruppen zu verbessern, ist diese Position genau das Richtige für Sie.

Benefits

PTO und schwimmende Feiertage

401K

Medizinische, zahnärztliche und visionäre Versicherung

Tuition Reimbursement

Mitarbeiterehrung

EAP (Mitarbeiterhilfeprogramm)

Qualifications

• Mindestens zwei Jahre Erfahrung in der Vertragsverhandlung mit Gesundheitsdienstleistern.
• Kenntnisse über verschiedene medizinische Vergütungsplattformen erforderlich.

Responsibilities

• Entwicklung und Pflege positiver Arbeitsbeziehungen mit Vertragsanbietern.
• Verhandlung von Verträgen mit Anbietern unter Verwendung verschiedener Strategien.

Skills

Verhandlungsgeschick

Kenntnisse in medizinischer Terminologie

Aufmerksamkeit für Details

MS-Office-Anwendungen (Word, Excel, Access)

Education

Bachelor in Gesundheitsverwaltung

Bachelor in Betriebswirtschaft

Job description

Why should you consider a career with Colorado Access?

We are a Colorado-based company, working to improve the health of our state.We care for individuals, families, and children who receive health care under Child Health PlanPlus(CHP+) and Health First Colorado (Colorado's Medicaid Program).Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion.

1. Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.
2. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference.
3. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

What you will do:

We are looking for a PROVIDER NETWORK CONTRACTOR who can help shape our vision and support our mission. Here is what the position will look like.

• Develops and maintains positive working relationships with potential contracted providers. Responds to and promptly addresses provider concerns related to current or pending contract provisions or requirements.
• Negotiates contracts with providers, to include addressing language, operational, and reimbursement provision concerns, and utilizes a variety of negotiation strategies and techniques. Coordinates language responses with Director when necessary.
• Maintains knowledge and understanding of current reimbursement methodologies by provider type, contract templates used for each line of business, and organization’s operations to ensure contract offers can be implemented efficiently and accurately.
• In collaboration with the Director, Senior Network Contractors, and other Network Contractors, evaluates network adequacy and ensures that provider capacity targets are achieved within the service area.
• Manages the entire contracting process including provider recruitment, contract negotiation, execution and implementation.
• Works with contracted providers and internal departments to address and resolve any contract interpretation, operational or reimbursement issues.
• Coordinates notification and dissemination of contract terms and relevant information to other departments as appropriate.

Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization.

Pay, Perks and Benefits at Colorado Access:

The compensation for this position is $77,200.00 - $94,800.00annually. Colorado Access has provided a compensation range that represents its good faith estimate of what Colorado Access may pay for the position at the time of posting. Colorado Access may ultimately pay more or less than the posted compensation range. The salary offered to the selected candidate will be determined based on factors such as the qualifications of the selected candidate, departmental budget availability, internal salary equity considerations, and available market information, but not based on a candidate’s sex or any other protected status.

In addition to being part of a mission driven organization serving our community, as an eligible Colorado Access employee, you’ll receive a generous benefits package, that includes:

• Medical, dental, vision insurance that starts the first day of the month following start date.
• Supplemental insurance such as critical illness and accidental injury.
• Health care and dependent care flexible spending account options.
• Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
• Short-term and long-term disability coverage.
• Voluntary life insurance (employee, spouse, dependent).
• Paid time off
• Retirement plan
• Tuition reimbursement (based on eligibility).
• Annual bonus program (based on eligibility, requirements and performance).

Where you will work:

This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’

We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of Colorado.

What you will bring:

Education :Bachelor’s degree in health administration, business administration or related field. Equivalent combination of experience and/or education may substitute, with a preference for four years’ progressive relevant work experience.

Experience : Minimum of two years’ experience negotiating contracts with health care providers (e.g., clinics, medical groups, ancillary providers and facilities) required.

Knowledge, Skills, and Abilities : Working knowledge of the various medical reimbursement platforms including the Resource Based Relative Value System, Medicaid, Ambulatory Payment Classification, and Diagnostic Related Groups required. Basic knowledge of managed care contracting, provider reimbursement methodologies, claims payment operations, medical terminology, and health care delivery systems required. Demonstrates support for the company’s mission, vision and values. Must have strong negotiation skills and strategy. Position requires excellent written and verbal communication skills.

Strong attention to detail, and the ability to handle and prioritize multiple tasks simultaneously required. Ability to deal with multiple levels of staff, work independently with little direction, and initiate work priorities. Must be proficient in MS-Office applications (Word, Excel, Access). May be required to manage multiple priorities and projects with tight deadlines.

Licenses/Certifications : A valid driver's license and proof of current auto insurance will be required for any position requiring driving.