Network Contractor - Provider Network Management (PNM)

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 is a fully remote position that requires visits to provider offices and attendance at in-person meetings at the company’s Delaware office. The role supports network development and provider satisfaction, education, and communication; negotiates contracts and Single Case Agreement rates; and helps maintain an adequate, compliant, and marketable provider network. The Contractor works with Corporate Provider Network Management on the annual contracting schedule and network updates, supports complex payment and fee-schedule needs, and collaborates with Account Executives and Legal.

Requirements

At least 3 years of Account Executive experience.
At least 1 year of contract negotiation experience.
Financial acumen.
Ability to have difficult conversations.
Understanding of reimbursement methodologies, including risk or Value-Based Contracting.
Proficiency using the MS Office Suite.
Valid driver’s license, car insurance, and reliable transportation.
Bachelor’s degree preferred; 5 or more years of experience if a bachelor’s degree is not held.

Nice To Haves

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 rates and convert Single Case Agreement providers to contracted providers.
Recruit and contract providers based on identified high-complexity network adequacy gaps.
Ensure contracts comply with applicable federal and state rules, regulations, policies, and procedures, and follow 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 providers become available or are 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 with 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.
Review contract language and collaborate with Legal to ensure the best contract terms.
Support contracting for multiple product lines, including Exchange and DSNP.
Lead Value-Based Contracting negotiations in conjunction with an Account Executive.