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Provider Contract Specialist at WellCare Health Plans in Cypress, California

Posted in Marketing 30+ days ago.

This job brought to you by Professional Diversity Network, Inc

Type: Full Time

Job Description:

The incumbent will be responsible for supporting business people in our local WellCare markets in negotiating contracts with hospitals, physician groups and other providers to participate in our provider network, including taking a major role in reviewing, analyzing and drafting contract language as part of those negotiations. This role will also support other legal matters related to provider relations, including assisting with disputes, provider manual support, provider communication review and other issues.
Department: Legal
Location: Cypress, CA
Reports To: Senior Manager Provider Contracts
Essential Functions:
Collaborate with Network representatives and WellCare attorneys in various markets on all aspects of contracting with new and existing providers in networks across several states
Support strategic positioning for provider contacting, assist in development of contract templates and help identify opportunities for great value-orientation and new payment methodologies
Contribute to development of alternative networking initiatives and new provider business strctures
Support attorneys and clients on provider relations issues
Perform other duties and work on projects as assigned Additional Responsibilities:
Candidate Education:
Preferred A Bachelor's Degree in a related field Business, Finance or Accounting
Preferred Other If a paralegal, certification/degree with contract specialization Candidate Experience:
Required 5 years of experience in Front line provider contracting supporting a health plan, health insurance company or hospital/physician network in either business or legal department Candidate Skills:
Advanced Ability to communicate and make recommendations to upper management
Advanced Ability to drive multiple projects
Advanced Ability to effectively present information and respond to questions from peers and management
Intermediate Ability to influence internal and external constituents
Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
Advanced Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
Advanced Ability to work in a fast paced environment with changing priorities
Advanced Demonstrated written communication skills
Intermediate Knowledge of healthcare delivery
Advanced Demonstrated problem solving skills
Advanced Demonstrated analytical skills
Intermediate Ability to work independently
Advanced Ability to work within tight timeframes and meet strict deadlines
Advanced Demonstrated negotiation skills
Intermediate Ability to work in a matrixed environment
Intermediate Ability to analyze information and convert related activities into a comprehensive work plan Licenses and Certifications:
A license in one of the following is required:
Preferred Other If paralegal, certification Technical Skills:
Required Intermediate Microsoft Excel
Required Intermediate Microsoft PowerPoint
Required Intermediate Microsoft Outlook
Required Intermediate Microsoft Word
Required Intermediate Other Emptoris or other contract management software experience Languages:
About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.