The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Executive works on problems of diverse scope and complexity ranging from moderate to substantial.
The Provider Contracting Executive communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
6+ years of progressive network management experience including hospital contracting and network administration in a healthcare company
Experience with Medicare contracting
2+ years of project leadership experience
Extensive provider contracting skills, including contract preparation and implementation, financial analysis and rate proposal development
Excellent written and verbal communication skills and experience presenting to varied audiences
Ability to manage multiple priorities in a fast-paced environment
Knowledge of Microsoft Office applications
Valid driver's license with reliable transportation and the ability to travel within the region up to 50%
Experience with ACO/Risk Contracting
Experience with Value Based Contracting
Experience with icertis contract management system
This role is considered "work at home", however, you must reside in either Massachusetts, Maine, or New Hampshire as you will be required to travel up to 50% within the region.
Scheduled Weekly Hours