Managed Care - Contract Negotiator _ Remote
- Responsible for contract management, assist with review of contract language between provider and payor, assist with the development and recruitment of provider(s) for narrow networks, ensure contracts comply according to Federal and State regulations.
- Extensive Contract Negotiation experience required
- Value based and Healthcare experience required
- California and Texas Contract Negotiations strongly preferred
Here we Grow! Because the need to care for children in this age is growing and changing, we are looking for an intelligent, caring Contract Negotiator who will join a mission-driven group that is focused on the health of children and the well-being of the family from an operational perspective. Our healthcare practice has grown from its South Florida roots since 1955 across Texas, California, Arizona, New York and there is more to come. At Pediatric Associates, our employees receive competitive salary, a generous PTO program, competitive benefits including a 401K with a Company match of up to 3.5%. With over 65 years of providing LOVING CARE to our patients, we offer the stability and security of an established practice with the excitement of a growing healthcare organization.
Apply on line, email or call us directly, and learn why this is a rewarding career move for you! This is a wonderful time to join our Big Orange PA Family!
Benefits at a glance:
- 3 Comprehensive Medical Plans
- Part Time Medical Plan
- Basic Life and Accidental Death and Dismemberment (AD&D) Company Paid
- Long Term Disability (LTD) Company Paid
- Short Term Disability (STD)
- Voluntary Term Life Insurance (Employee/Spouse/Child)
- 401K Retirement Plan
- Voluntary Benefit Plans
- Life Assistance Plan (EAP)
- Tuition Reimbursement
- Paid Time Off
- Paid Holidays
- PRIMARY FUNCTION
- Responsible for contract management, assist with review of contract language between provider and payor, assist with the development and recruitment of provider(s) for narrow networks, ensure contracts comply according to Federal and State regulations. Supports the Director of Managed Care and Contracting Manager in strategic local market/national negotiations to include Risk and Value Based Contracting.
- ESSENTIAL FUNCTIONS OF THE JOB
- This list may not include all of the duties that may be assigned.
- Support the Contracting Manager in negotiations including Risk, Value Based, Fee for Service, and provider specific contracts
- Perform contract language review and support in negotiating language changes/terms/provisions with payors to maximize reimbursement, reduce exposure, and streamline administration
- Gather and analyze data for managed care contract negotiations
- Review and maintain contract renewal schedule to ensure contracts are negotiated timely
- Ensure provider compliance with contract terms and legal regulations
- Research all state and federal regulations that may impact the performance of the contract
- Identify contracting opportunities with existing payor Agreements
- Monitor contract financial performance including Capitation, Risk, Gainshare, Pay for Performance, and Bonus arrangements.
- Perform any other duties as assigned
- PERFORMANCE REQUIREMENTS:
- Education: Bachelor’s degree preferred. AA plus a minimum of 5 years of related experience is commensurate to the education preferred.
Knowledge, Skills & Abilities:
1. Knowledge in Risk and Value Based Contracting
2. Effective strategic planning and organizational skills
3. Knowledge of Statewide Medicaid Managed Care programs and Commercial payors
4. Proficient in research, analysis, and interpretation of financial data and trends
5. Knowledge of reimbursement methodologies and CPT, ICD10, RBRVS, and capitation.
6. Knowledge of claims, credentialing, and loading processes
7. Advanced Microsoft Office skills
8. Effective oral and written communication skills
9. Ability to manage multiple priorities and projects
10. Strong interpersonal skills
- Minimum of 3 years’ experience required. Previous healthcare experience required.
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.
- Being fully vaccinated against COVID-19 is required unless approved for a medical or religious exemption.