The Provider Contracting Executive is responsible for contracting relationships with physicians, physician groups, institutions and ancillary providers including the development of contracting strategies, coordination of analytical support, negotiation, and effective administration. They cultivate and maintain relationships with key providers and promote innovative products and reimbursement methodologies.
Normally to be proficient in the competencies listed below
The Provider Contracting Executive would have a Bachelor's Degree in healthcare, business or a related field and 5 years' experience in a healthcare industry provider contracting, relations, or analytical capacity or equivalent combination of education and experience.
Maintains and expands the health care delivery system network by negotiating contracts and maintaining relationships with providers.
Cultivates relationships with providers that position the organization to meet its objectives relating to cost effectiveness, quality of care, enrollment growth, administrative efficiency, product positioning and profitability.
Monitors financial and utilization performance of contracts and develops plans to improve performance with the Health Care Services division.
Regularly meets with key provider leaders to review cost/utilization reports, prepares analysis, recommends strategies, researches problem issues and serves as the primary "client manager."
Develops and maintains new regional networks to support the introduction of new products, maintaining a high understanding of the health plan market pricing and communicates the strategic benefits to providers of participating in new networks and products.
Works collaboratively with the provider consultants and representatives to ensure that contracts are appropriately administered and that improvement plans are being managed.
Supports specific initiatives (based on potential cost savings and the impact on member care and providers) which will reduce our healthcare expenditures while still delivering the best care possible to our members.
Develops and manages risk arrangements including developing, arranging and maintaining pricing and accountable health system funding arrangements.
Develops long and short range contracting strategies for each delivery system assigned.
Strong understanding of managed care and accountable health system models and relationship to contracting strategy and reimbursement methodology.
Proven ability to build positive relationships and negotiate successfully with institutional, professional, and ancillary providers.
Demonstrated competency related to varying payment methodologies and value base contracting. (such as Pay for Quality/Performance, DRG, APC, ASC, Capitation, Fee for Service, RBRVS, Per Diem, Per Case)
Ability to analyze financial, quality, and utilization data and use to develop contracting strategies. Ability to organize and manage a portfolio of contracts.
Ability to work in high-pressure circumstances and effectively manage conflict and ambiguity. Senior Provider Contracting (requirements in addition to above)
Proficiency building relationships and negotiating successfully with large and complex market-leading institutional and professional providers.
Ability to independently and effectively communicate with high level executives internally and externally.
Required Licenses, Certifications, Registration, Etc.
Valid driver's license.
This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.