Provider Network Contractor

Colorado Access • Denver, CO

253d • $77,200 - $94,800 • Onsite

About The Position

Colorado Access is a Colorado-based company dedicated to improving 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 on 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. We offer work/life balance with PTO, floating holidays, nine company-paid holidays, a hybrid work environment, an Employee Assistance Program, and a 401K. Join us to make an impact by serving the underserved and vulnerable populations in our community through access to quality and affordable health care. We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

Requirements

• Bachelor's degree in health administration, business administration, or related field.
• Minimum of two years' experience negotiating contracts with health care providers (e.g., clinics, medical groups, ancillary providers, and facilities).
• Working knowledge of various medical reimbursement platforms including the Resource Based Relative Value System, Medicaid, Ambulatory Payment Classification, and Diagnostic Related Groups.
• Basic knowledge of managed care contracting, provider reimbursement methodologies, claims payment operations, medical terminology, and health care delivery systems.
• Strong negotiation skills and strategy.
• Excellent written and verbal communication skills.
• Strong attention to detail and the ability to handle and prioritize multiple tasks simultaneously.
• Ability to deal with multiple levels of staff, work independently with little direction, and initiate work priorities.
• Proficiency in MS-Office applications (Word, Excel, Access).
• Valid driver's license and proof of current auto insurance required for any position requiring driving.

Nice To Haves

• Four years' progressive relevant work experience preferred.

Responsibilities

• Develop and maintain positive working relationships with potential contracted providers.
• Respond to and promptly address provider concerns related to current or pending contract provisions or requirements.
• Negotiate contracts with providers, addressing language, operational, and reimbursement provision concerns using various negotiation strategies and techniques.
• Coordinate language responses with the Director when necessary.
• Maintain 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.
• Evaluate network adequacy in collaboration with the Director, Senior Network Contractors, and other Network Contractors, ensuring provider capacity targets are achieved within the service area.
• Manage the entire contracting process including provider recruitment, contract negotiation, execution, and implementation.
• Work with contracted providers and internal departments to address and resolve any contract interpretation, operational, or reimbursement issues.
• Coordinate notification and dissemination of contract terms and relevant information to other departments as appropriate.

Benefits

• 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).

What This Job Offers

• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree