Senior Network Contracting Specialist (Mid West Region)

Responsibilities

• Manages contract negotiations with large physician groups and ancillary providers; conducting several negotiations simultaneously to meet growth demands
• Deep understanding and experience with all clinical specialties to ensure contract terms and conditions address the coding structures which are most impacted by negotiations
• Proactively builds relationships that nurture provider partnerships to support the local market strategy
• Initiates, nurtures, and maintains effective channels of communication with matrix partners including but not limited to, Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing
• Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position
• Identifies and manages initiatives that improve total medical cost and quality; including renegotiation of existing agreements
• Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms
• Collaborates cross-functionally 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
• Assists in resolving elevated provider service complaints; researching and negotiating with internal/external partners/customers to resolve complex and/or escalated issues
• Manages key provider relationships and is accountable for critical interface with providers and business staff
• Coach and support new team members on negotiation strategies and approaches to successful
• Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape
• 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

Position Requirements

• Bachelor’s degree or equivalent experience in related field, including 7+ years of work experience with hospitals and providers beyond degree within provider contracting and/or health insurance
• Existing relationships with major health systems and large physician groups within the region is required
• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
• Experience with Physician group and ancillary provider contracting and negotiations
• Experience negotiating delegated credentialing agreements
• Experience in developing and managing key provider relationships including senior executives
• Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
• Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models
• Team player with proven ability to develop strong working relationships within a fast-paced organization
• The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations
• Customer centric and interpersonal skills are required

Perks & Benefits

• Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)
• $0 copays and $0 deductibles (with completion of our Baseline Visit )
• Preventive and primary care built in
• Mental health support (Rula, Televero, Two Chairs, Recovery Unplugged)
• One-on-one care navigation
• Chronic condition programs (diabetes, weight, hypertension)
• Maternity and family planning support
• 24/7/365 Curative Telehealth
• Pharmacy benefits
• Comprehensive dental and vision coverage
• Employer-provided life and disability coverage with additional supplemental options
• Flexible spending accounts
• Flexible work options: remote and in-person opportunities
• Generous PTO policy plus 11 paid annual company holidays
• 401K for full-time employees
• Generous Up to 8–12 weeks paid parental leave, based on role eligibility.