Network Contractor PNM

Amerihealth Caritas•Washington, DC

2d•$92,800 - $126,400•Hybrid

About The Position

As a Provider Network Management Contractor, you will be responsible for the contracting and re-contracting of providers in an established market. This position is a 4 days / week hybrid position in our DC office located at 1201 Maine SW. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Requirements

Associates Degree required.
Minimum of three (3) years of Account Executive experience.
Minimum of one (1) year of contract negotiation experience.
Understanding of reimbursement methodologies to include Risk or Value Based contracting.
Ability to have difficult conversations.
Financial acumen.
Proficiency using MS Office Suite.
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required.

Nice To Haves

Bachelor's Degree preferred.
Master's Degree highly preferred.

Responsibilities

Supports network development strategy.
Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication.
Responsible for negotiating contracts to execute on network strategy and ensure an adequate, compliant and marketable network.
Responsible for negotiating Single Case Agreement (SCA) rates and converting SCA providers to contracted.
Responsible for recruiting and contracting providers based on identified network adequacy gaps (high complexity).
Ensures all contracts are negotiated to be compliant with Federal and State rules, regulations, policies and procedures and follow all departmental policies.
Ensures contracts are supportive of Plan quality initiatives such as HEDIS, CAHPS and NCQA/URAC.
Negotiates contracts to support management of provider satisfaction.
Contractors will work with Corporate Provider Network Management to manage the annual contracting schedule as well as supplement the network as new providers are available or needed.
Payment/fee schedule SME’s to develop resources in complex specialties i.e. FQHCs, BH, anesthesia etc. These SMEs will be available to AEs when needed for support of claims resolution.
General Operational Knowledge related to provider satisfaction, education and communication with a fundamental understanding of operational items such as claims, payment integrity, provider data, credentialing, appeals disputes etc.
Negotiates provider contracts consistent with claim payment methodologies.
Augments and modifies the existing provider network to accommodate new products or clients as necessary.
Reviews contract language and collaborates with legal to ensure best contract terms.
Support contracting for multiple product lines, including Exchange, DSNP.
Lead negotiator of Value Based Contracting in conjunction with AE.