Senior Provider Network Contracting

Senior Provider Network Contracting

Requirements

• Critical thinking to maintain cost management and a fully engaged network of participating hospitals, ancillaries and providers.
• A minimum of 5 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with hospitals.
• Understanding knowledge of Value Based Contracting.
• Microsoft Office/Excel proficient.

Responsibilities

• Guides development of holistic solutions or strategic plans negotiates and executes contracts with the most complex, market /region/national, largest group/system or highest value/volume of spend providers with significant financial implications.
• Manages contract performance, and drives the development and implementation of value based contract relationships in support of business strategies.
• Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
• Accountable for cost arrangements within defined groups.
• Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
• Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives.
• Represents company with high visibility constituents, including customers and community groups.
• Promotes collaboration with internal partners.
• Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.
• Collaborates with internal partners to assess effectiveness of tactical plan in managing costs.
• May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
• Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

Preferred Qualifications

• Healthcare Industry experience with either a payer or provider
• Strong communication, critical thinking, problem resolution and interpersonal skills.
• Internal Aetna system knowledge a plus.
• Understanding of Medicare & Commercial.
• Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.