GENERAL SUMMARY
Assists with managed care contracting with physicians and ancillary providers for all contracts pertaining to fully insured, Health Plan, PPO, corporate accounts, lease networks and workers’ compensation. Performs ongoing network analysis. Recruits and contracts with individual providers who meet established selection criteria to assure adequate geographic and specialty coverage. Makes recommendations for retention or delistment of providers.
ESSENTIAL RESPONSIBILITIES
- Responsible for research, analysis, and negotiation support of contract agreements for all contracts pertaining to fully insured, Health Plan, PPO, corporate accounts, lease networks and workers’ compensation.
- Develops and implements a formal, documented ongoing program to ensure good communications with all physicians and other providers.
- Assists managers and staff in planning, recruiting and implementing the physician and hospital network.
- Assists managers and staff with the development and monitoring of provider contracts. Prepares and evaluates reports regarding the provider network.
- Manages the addition and termination of providers into the network. Ensures the accuracy of provider data entered into the provider database.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Previous (usually 3+ years) experience in provider contract negotiation.
- Substantive knowledge of managed care policy and direction.
- Knowledge of ICD-9 and CPT codes desired.
- 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: Oklahoma City, OK, US
Organization: 13000 - CHC of Kansas
Schedule: Full-time
Job Posting: 2013-01-11 00:00:00.0
Job ID: 1212776