Network Contractor Provider Network Management

Amerihealth Caritas•Newark, DE

1d•Remote

About The Position

The Network Contractor is responsible for contracting and re-contracting providers in an established market. This fully remote position requires the Associate to be located in Delaware to attend in-office meetings as needed. The role supports network development strategy and helps maintain an adequate, compliant, and marketable provider network across multiple product lines, including Exchange and DSNP. It also includes payment and fee-schedule subject-matter expertise in complex specialties and support for claims resolution.

Requirements

Bachelor's degree; the posting states that 5 or more years of experience is preferred if the candidate does not have a bachelor's degree.
3 or more years of Account Executive experience.
Financial acumen.
Ability to have difficult conversations.
1 or more years of contract negotiation experience.
Understanding of reimbursement methodologies, including risk or Value Based contracting.
Proficiency using the MS Office Suite.

Nice To Haves

5 or more years of experience if the candidate does not have a bachelor's degree.

Responsibilities

Support network development strategy.
Assist the Leader with departmental activities related to provider satisfaction, education, and communication.
Negotiate provider contracts to execute network strategy and ensure an adequate, compliant, and marketable network.
Negotiate Single Case Agreement (SCA) rates and convert SCA providers to contracted providers.
Recruit and contract providers based on identified network adequacy gaps, including high-complexity gaps.
Ensure contracts comply with applicable federal and state rules, regulations, policies, procedures, and departmental policies.
Ensure contracts support Plan quality initiatives, including HEDIS, CAHPS, and NCQA/URAC.
Negotiate contracts to support provider satisfaction.
Work with Corporate Provider Network Management on the annual contracting schedule and supplement the network as new providers become available or needed.
Serve as a payment and fee-schedule subject-matter expert for complex specialties such as FQHCs, behavioral health, and anesthesia, and provide support to Account Executives for claims resolution when needed.
Apply general operational knowledge related to provider satisfaction, education, and communication, including claims, payment integrity, provider data, credentialing, appeals, and disputes.
Negotiate provider contracts consistent with claim payment methodologies.
Augment and modify the existing provider network to accommodate new products or clients as needed.
Review contract language and collaborate with Legal to secure appropriate contract terms.
Support contracting across multiple product lines, including Exchange and DSNP.
Lead Value Based Contracting negotiations in conjunction with the Account Executive.