Senior Network Contracting Specialist
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About The Position
The Senior Network Contracting Specialist is responsible for managing contract negotiations with large physician groups and ancillary providers, conducting several negotiations simultaneously to meet growth demands. This role requires a deep understanding and experience with all clinical specialties to ensure that contract terms and conditions address the coding structures most impacted by negotiations. The specialist will proactively build relationships that nurture provider partnerships to support the local market strategy and will initiate, nurture, and maintain effective channels of communication with matrix partners including Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales, and Marketing. The position is also responsible for meeting unit cost targets while preserving an adequate network to achieve and maintain a competitive position. The specialist will identify and manage initiatives that improve total medical cost and quality, including the renegotiation of existing agreements. They will prepare, analyze, review, and project the financial impact of high spend or increasingly complex provider contracts and alternate contract terms. Collaboration across functions is essential to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities. Additionally, the specialist will assist in resolving elevated provider service complaints by researching and negotiating with internal and external partners/customers to resolve complex and/or escalated issues. They will manage key provider relationships and be accountable for critical interfaces with providers and business staff. Coaching and supporting new team members on negotiation strategies and approaches to success is also a key responsibility. The specialist must demonstrate comprehensive knowledge of providers in an assigned geographic area, understanding the interrelationships and competitive landscape. Finally, they will partner with Regulatory Affairs to ensure all network filings are timely and accurate, including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity.
