Provider Contracting Executive or Senior, DOE

Cambia Health Solutions • Washington, DC

8d • $79,000 - $155,000 • Hybrid

About The Position

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Every day, Cambia’s dedicated team of Provider Contracting Executives are living our mission to make health care easier and lives better. As a member of the Provider Contracting team, our Provider Contracting Executives lead the development and management of strategic contracting relationships with top-tier physicians, groups, institutions, and ancillary providers. Drive business growth through innovative products and reimbursement methodologies, while cultivating and maintaining key relationships and overseeing complex contract negotiations and administration – all in service creating a person-focused health care experience. Do you have a passion for serving others and driving business growth? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

Requirements

• Bachelor’s Degree in healthcare, business or a related field
• 5 years’ experience in a healthcare industry provider contracting, relations, or analytical capacity or equivalent combination of education and experience (for Provider Contracting Executive)
• 7 years’ experience in a healthcare industry provider contracting, relations or analytical capacity or equivalent combination of education and experience (for Provider Contracting Executive Senior)
• Strong understanding of managed care and accountable health system models, and their relationship to contracting strategy and reimbursement methodology.
• Proven ability to build positive relationships and negotiate successfully with institutional, professional, and ancillary providers.
• Demonstrated competency in varying payment methodologies, including Pay for Quality/Performance, DRG, APC, ASC, Capitation, Fee for Service, RBRVS, Per Diem, and Per Case.
• Strong understanding of value-based programs and contracting models.
• Proficiency and comfort in negotiating complex contract language.
• Ability to analyze financial, quality, and utilization data to develop contracting strategies and manage a portfolio of contracts.
• Ability to work effectively in high-pressure circumstances, managing conflict and ambiguity.
• Proficiency in building relationships and negotiating successfully with large, complex, and market-leading institutional and professional providers, and ability to independently and effectively communicate with high-level executives internally and externally.
• Ability to oversee and manage a portfolio of contracts and provide leadership and guidance to others in the organization.
• Wired internet connection that is not satellite or cellular with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
• Access to a personal mobile device to set up Multi-Factor Authentication (MFA).

Nice To Haves

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Responsibilities

• Maintains and expands the health care delivery system network by negotiating contracts and maintaining relationships with providers, positioning the organization to meet its objectives relating to cost effectiveness, quality of care, enrollment growth, administrative efficiency, product positioning, and profitability.
• Monitors financial and utilization performance of contracts, develops plans to improve performance, and meets with key provider leaders to review reports, prepare analysis, and recommend strategies.
• Develops and maintains new regional networks to support the introduction of new products, understanding health plan market pricing and communicating strategic benefits to providers.
• Collaborates with provider consultants and representatives to ensure contracts are administered appropriately and improvement plans are managed.
• Develops and manages risk arrangements, including pricing and accountable health system funding arrangements, and leads plan initiatives/pilots focused on provider network configuration, reimbursement, and management.
• Develop long and short-range contracting strategies for each delivery system assigned, with a focus on reducing healthcare expenditures while delivering high-quality care to members.
• Serves as a mentor to Provider Contracting Executives and others within the department, providing resources and guidance to support the organization's objectives.

Benefits

• Competitive salary
• Market-leading 401(k) with a significant company match
• Bonus opportunities
• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure
• 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level