Senior Network Contracting Specialist

Valid8 Financial, Inc.; Austin (TX); Remote; USD 90,000 - 120,000; Full time

Job summary

A leading financial company seeks a Provider Contract Manager to oversee contract negotiations with physician groups and ancillary providers. The ideal candidate will have extensive experience in health insurance provider relations, strong negotiation skills, and a track record of managing key relationships. This position is remote with occasional travel required. A Bachelor’s degree and 7+ years of relevant experience are essential.

Qualifications

• 7+ years of work experience within provider contracting and/or health insurance.
• Existing relationships with ancillary providers and large physician groups in Texas.
• Demonstrated experience in managing key provider relationships.

Responsibilities

• Manage contract negotiations with provider groups and maintain effective communication.
• Analyze financial impacts of provider contracts and manage cost initiatives.
• Coach new team members on negotiation strategies.

Skills

Negotiating Skills

Decision-Making

Problem Solving

Interpersonal Skills

Customer Centricity

Education

Bachelor’s degree

Job description

Manages contract negotiations with large physician groups and ancillary providers; conducting several negotiations simultaneously to meet growth demands

Deep understanding and experience with all clinical specialties to ensure contract terms and conditions address the coding structures which are most impacted by negotiations

Proactively builds relationships that nurture provider partnerships to support the local market strategy

Initiates, nurtures, and maintains effective channels of communication with matrix partners including but not limited to, Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing

Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position

Identify and manages initiatives that improve total medical cost and quality; including renegotiation of existing agreements

Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms

Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities.

Assists in resolving elevated provider service complaints; researching and negotiating with internal/external partners/customers to resolve complex and/or escalated issues.

Manages key provider relationships and is accountable for critical interface with providers and business staff

Coach and support new team members on negotiation strategies and approaches to successful

Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape

Partner with Regulatory Affairs to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity

Position Requirements

Bachelor’s degree or equivalent experience in related field, including 7+ years of work experience beyond degree within provider contracting and/or health insurance

• Remote with occasional travel (5-10%)
• Existing relationships with ancillary providers and large physician groups in Texas
• 7+ years of experience with health plan or provider organizations

Superior problem solving, decision-making, negotiating skills, contract language and financial acumen

Experience with Physician group and ancillary provider contracting and negotiations

Experience in developing and managing key provider relationships including senior executives

Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners

Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models

Team player with proven ability to develop strong working relationships within a fast-paced organization

The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations

Customer centric and interpersonal skills are required