Provider Network Contractor

Colorado Access•Denver, CO

12d•$78,200 - $93,700•Hybrid

About The Position

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care. Why should you consider a career with Colorado Access? We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion. Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend. What you will do: We are looking for a PROVIDER NETWORK CONTRACTOR who can help shape our vision and support our mission. Here is what the position will look like.

Requirements

Education: Bachelor’s degree in health administration, business administration or related field. Equivalent combination of experience and/or education may substitute, with a preference for four years’ progressive relevant work experience.
Experience: Minimum of two years’ experience negotiating contracts with health care providers (e.g., clinics, medical groups, ancillary providers and facilities) preferred.
Knowledge, Skills, and Abilities: Working knowledge of the various medical reimbursement platforms including the Resource Based Relative Value System, Medicaid, Ambulatory Payment Classification, and Diagnostic Related Groups required. Basic knowledge of managed care contracting, provider reimbursement methodologies, claims payment operations, medical terminology, and health care delivery systems required. Demonstrates support for the company’s mission, vision and values. Must have strong negotiation skills and strategy. Position requires excellent written and verbal communication skills.
Strong attention to detail, and the ability to handle and prioritize multiple tasks simultaneously required. Ability to deal with multiple levels of staff, work independently with little direction, and initiate work priorities. Must be proficient in MS-Office applications (Word, Excel, Access). May be required to manage multiple priorities and projects with tight deadlines.
Licenses/Certifications: A valid driver's license and proof of current auto insurance will be required for any position requiring driving.

Responsibilities

Develops and maintains positive working relationships with potential contracted providers. Responds to and promptly addresses provider concerns related to current or pending contract provisions or requirements.
Negotiates contracts with providers, to include addressing language, operational, and reimbursement provision concerns, and utilizes a variety of negotiation strategies and techniques. Coordinates language responses with Director when necessary.
Maintains knowledge and understanding of current reimbursement methodologies by provider type, contract templates used for each line of business, and organization’s operations to ensure contract offers can be implemented efficiently and accurately.
In collaboration with the Director, Senior Network Contractors, and other Network Contractors, evaluates network adequacy and ensures that provider capacity targets are achieved within the service area.
Manages the entire contracting process including provider recruitment, contract negotiation, execution and implementation.
Works with contracted providers and internal departments to address and resolve any contract interpretation, operational or reimbursement issues.
Coordinates notification and dissemination of contract terms and relevant information to other departments as appropriate.

Benefits

We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.
Medical, dental, vision insurance that starts the first day of the month following start date.
Supplemental insurance such as critical illness and accidental injury.
Health care and dependent care flexible spending account options.
Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
Short-term and long-term disability coverage.
Voluntary life insurance (employee, spouse, dependent).
Paid time off
Retirement plan
Tuition reimbursement (based on eligibility).
Annual bonus program (based on eligibility, requirements and performance).