GENERAL SUMMARY
Assists with implementing specialist and ancillary provider contracts and Integrated Delivery System contracts as assigned; may also be responsible for maintenance of the NCQA designation/accreditation process.
ESSENTIAL RESPONSIBILITIES
- Acts as primary contact for providers who have new contracts. Investigates any questions or issues they may have during the initial implementation process. Recommends solutions.
- Acts as internal contact for all departments impacted by the assigned provider contract.
- Responsible for financial analysis of proposed capitation or risk sharing arrangements.
- Assists with tracking the network development done by the provider and for determining the most effective set up of the provider network. Investigates any issues/set-up problems that arise with the appropriate departments.
- Determines the necessary technology interfaces needed by the provider from Coventry and works with the IS Department for development and roll out. Investigates all interface problems as they arise.
- Facilitates ongoing internal meetings to share and distribute contract information and to review the action plans and answer questions.
- Supports other areas of Network Operations as required, including assisting with the accreditation process.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Significant experience (usually 3+ years) exposure to provider contracting.
- Substantive knowledge of managed care policy and direction.
- Knowledge of ICD-9 and CPT codes desired.
- Strong software skills.
- Strong analytic and problem solving abilities.
- Strong communication and negotiation skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Tampa, FL, US
Organization: 10000 - Coventry Health Care - Corp
Schedule: Full-time
Job Posting: 2012-12-26 00:00:00.0
Job ID: 1212765