GENERAL SUMMARY
Responsible for managed care contracting with facility and ancillary providers and performing ongoing network analysis for all contracts pertaining to fully insured, Health Plan, PPO, corporate accounts, lease networks and workers’ compensation. 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
- Under limited supervision, responsible for research, analysis, and negotiation 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 facilities and other providers.
- Responsible for negotiating complex hospital contracts. Coordinates all aspects of contracting activities as related to Information Systems, Claims and Medical Management.
- Develops and recommends to senior management appropriate reimbursement methodologies. Coordinates the preparation of financial impact analysis.
- Assists senior management with provider pricing forecasts and analysis of reimbursement for new technologies.
- Assists senior management and staff in planning, recruiting and implementing the hospital network.
- Assists senior management 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.
- Significant experience (usually 6+ years) in provider contracting, three years in hospital contracting.
- Substantive knowledge of managed care policy, reimbursement methodologies and contracting tactics.
- Knowledge of ICD-9, CPT codes and DRG/Case Rate pricing required.
- Strong analytic and problem solving abilities.
- Strong communication and negotiation skills.
- Demonstrated record of successful hospital contract negotiations.
- Exhibits considerable initiative in formulating provider contracting strategy.
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: Metairie, LA, US
Organization: 14000 - CHC of Louisiana
Schedule: Full-time
Job Posting: 2012-12-13 00:00:00.0
Job ID: 1212558