Sr Network Development Executive

Claritev•New York, NY

About The Position

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders — internal and external — driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential. Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!! -------------------------------------------------------------------------------- Job Summary This position is responsible for identifying and evaluating opportunities in support of network-based solutions by negotiating optimal reimbursement rates and drafting contracts for network and non-network providers to support commercial and government products. This activity will ensure patient access to the highest quality, cost-effective providers of healthcare services in accordance with applicable regulations and the Company’s policies, practices, and procedures. In addition, this position is responsible for working with management in the aggressive execution of regional strategies based on market trends and client expectations, as well as continuous evaluation of assigned territory penetration and discounts. This role may support other areas such as Payment Integrity and Analytics-Based Services. -------------------------------------------------------------------------------- Job Scope The incumbent is considered to be a senior staff professional who applies comprehensive knowledge of principles, practices, and procedures related to the completion of complex or difficult negotiation and maintenance of provider network contracts. This role works independently and has substantial latitude for unreviewed action or discretion and may have authorization to act outside standardized procedures. The incumbent may assist less experienced Provider Contractors in resolving complex issues and may act in a liaison capacity with other departments. This position does not directly manage others but may provide project or work direction to less experienced team members. The role may require overnight travel to meet with providers in assigned geographic areas and/or attend company-sponsored meetings and events. The incumbent will possess the skills necessary to strategize, construct, and negotiate complex financial rate structures and contract language and demonstrate successful negotiations requiring this skill set.

Requirements

Minimum Bachelor’s Degree in related or applicable field, or HS Diploma (or GED) and four (4) years' experience related to network development
Minimum 5 years experience in provider contracting and network development, including contracting experience with physicians, physician groups, hospitals, and ancillaries, or equivalent provider/payer experience
Knowledge of provider finance components including budget, charge structure, reimbursement formulas, and healthcare finance
Knowledge of provider organizations and operations applicable to assigned focus
Knowledge of the provider community and market dynamics, including interrelationships between hospitals, physicians, and ancillary services
Excellent communication (written, verbal, and listening), business acumen, analytical, negotiation, organization, strategic, multitasking, and prioritization skills
Ability to strategize, construct, and negotiate complex financial rate structures and contract language
Ability to manage multiple competing priorities
Ability to negotiate rate structures and contract language aligned with the Company’s business model while limiting risk
Ability to minimize non-standard language through strong understanding of contract structures
Ability to build trust and credibility across all levels of the organization
Ability to work collaboratively across teams and organizational boundaries
Ability to build relationships with internal and external customers
Ability to understand provider and competitor structures and relationships
Ability to manage in-person client interactions professionally
Ability to persuade and influence
Ability to effectively communicate the Company’s value proposition
Ability to travel, including overnight stays
Ability to present the Company in a professional manner
Ability to use computer software, hardware, and peripherals applicable to the role

Responsibilities

Assist management in the identification and development of contracting priorities for assigned territory to support Network Development provider contracting initiatives
Negotiate provider contracts to support penetration and discount objectives relative to competitive market trends and client expectations through comprehensive, aggressive execution of region-specific contracting goals
Foster and maintain superior provider relationships, including management of the business relationship with large, complex providers
Respond to provider questions, issues, and problems that have been appropriately escalated and produce a solution
Conduct complex internal audits and reviews of existing provider relationships and supporting documentation to resolve internal or external inquiries
Function as provider-specific expert by identifying, understanding, and documenting strategic business needs and market strategies
Maintain, and preferably exceed, contracting production and quality standards consistent with established regional goals
Prepare analyses, reports, and presentations by collecting, analyzing, and summarizing information and trends
Monitor, compare, and contrast market competitive information to develop and initiate growth strategies and assess network adequacy and marketability
Serve as mentor to less experienced Provider Contractors through ongoing instruction, coaching, modeling, and counseling
Work with Sales and Account Management to respond to and anticipate access requirements and network-related performance guarantees
Partner with HCE to conduct financial analyses and monitoring of market trends to identify, develop, and implement competitive reimbursement strategies
Collaborate, coordinate, and communicate across disciplines and departments
Develop and maintain positive relationships at all levels within the organization and communicate provider needs to applicable process owners
Ensure compliance with established policies and procedures and regulatory requirements (including but not limited to HIPAA)
Complete mandatory training requirements, including Human Resources, product orientation, and contracting tools and resources
Demonstrate Company’s Core Competencies and values
Perform other duties as assigned

Benefits

Medical, dental and vision coverage with low deductible & copay
Life insurance
Short and long-term disability
Paid Parental Leave
401(k) + match
Employee Stock Purchase Plan
Generous Paid Time Off – accrued based on years of service
10 paid company holidays
Tuition reimbursement
Flexible Spending Account
Employee Assistance Program
Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits