Provider Contracting Specialist

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Network & Contracting
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21018 Requisition #
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To manage the development and implementation of hospital, provider and ancillary contracts for ConnectiCare and assist in management of local provider units.

Responsibilities:

  • Works closely with delivery systems, Manager, Provider Contracting and internal CCI epartments to identify and evaluate new contracting opportunities for ConnectiCare and Affiliates.
  • Understands delivery system needs. Creates hospital, ancillary, and physician contracts to meet those needs. Works with ConnectiCare departments to design new contractual arrangements, which secure ConnectiCare's financial goals.
  • Negotiates terms of contractual arrangements with physicians, hospital representatives and
    other providers.
  • Negotiates rate renewals with provider representatives. Explains ConnectiCare financial terms to contracting parties.
  • Designs provider contract specifications and drafts contracts. Works closely with other departments as necessary to ensure cost effective quality services are provided. Performs financial and program analysis to assess costs and benefits of contracting alternatives.
  • Implement contracts and is liaison for contract implementation. Communicates requirements to all affected parties. Understands ConnectiCare’s internal requirements and capabilities for contracting. Educates providers on contracting terms.
  • Design payment systems, risk-sharing and capitation mechanisms to ensure that proper incentives are created and provider unit plans financial targets are met.
  • Analyzes geographic needs, referral patterns for ancillary and physician services, and recruits providers of these services to ensure sufficient success and contracted rates for all services utilized/required through the network. Communicates with appropriate parties on network issues including representatives of the delivery system and CCI business areas as appropriate.
  • Participates in team meetings to review provider unit progress to budget targets and ensures issues are resolved. Functions as an active team member by communicating ideas, concerns and issues and using quality improvement techniques to improve provider unit performance.
  • Performs other related projects and duties as assigned.

Qualifications:

  • Bachelor’s Degree or equivalent combination of education and experience
  • At least 2 years of previous experience in a health care organization with a focus on contracting and financial analysis required on the equivalent preferably working with customers/vendors
  • Excellent oral and written communication and interpersonal skills required
  • Excellent analytical skills required
  • Knowledge of financial risk arrangements and fee schedules, including understanding of health care reimbursement methodologies and guidelines preferred
  • Excellent presentation skills required
  • Car required. Must be able to travel within a defined geographic area

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