Description:
GENERAL SUMMARY
Responsible for provider contracting and/or provider relations functions pertaining to fully insured, Health Plan, PPO, corporate accounts, lease networks and workers’ compensation. Develops and implements department’s policies, procedures and practices. Responsible for integration of provider relations and/or
contracting activities with the priorities set by medical management and senior management.
ESSENTIAL RESPONSIBILITIES
- Assesses, recruits and organizes vendors for fully insured, Health Plan, PPO, corporate accounts, lease networks and workers’ compensation. Manages provider database function. Oversees maintenance of working relationships within the existing network and assists in the recruitment of new providers.
- Manages service to provider practices by providing leadership in educating providers, resolving problems and advising providers of new protocols, policies and procedures. Assists department personnel in resolving contract disputes related to claims inquiry.
- Negotiates complex contracts with physician, ancillary, and hospital providers. Acts in an advisory capacity with the Legal Department with regard to the financial and legal impact of provider contract language requested. Reports on status of all contracting activities.
- Coordinates and assures proper notification to all relevant departments of any new contracts once they are executed.
- Assists in the development of standardized fee schedules and their implementation in the consultant provider community.
- Maintains and services existing institutional and specialty contracts as needed.
- Develops and generates appropriate reports on size, magnitude, cost effectiveness and comparative marketability of networks for internal and external customers.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Perform other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Significant experience (usually 7+ years) in managed care with 2-3 years strategic operational experience in network development.
- Expert knowledge of provider contracting/negotiations, provider relations and configuration, standards for managed care delivery, and cost containment programs.
- In-depth experience with regulated lines of business.
- Substantive knowledge of managed care policy and direction.
- Strong communication and negotiation skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: Louisville, KY, US
Other Locations: ,
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2013-05-21 00:00:00.0
Job ID: 1311821
GENERAL SUMMARY
Responsible for provider contracting and/or provider relations functions pertaining to fully insured, Health Plan, PPO, corporate accounts, lease networks and workers’ compensation. Develops and implements department’s policies, procedures and practices. Responsible for integration of provider relations and/or
contracting activities with the priorities set by medical management and senior management.
ESSENTIAL RESPONSIBILITIES
- Assesses, recruits and organizes vendors for fully insured, Health Plan, PPO, corporate accounts, lease networks and workers’ compensation. Manages provider database function. Oversees maintenance of working relationships within the existing network and assists in the recruitment of new providers.
- Manages service to provider practices by providing leadership in educating providers, resolving problems and advising providers of new protocols, policies and procedures. Assists department personnel in resolving contract disputes related to claims inquiry.
- Negotiates complex contracts with physician, ancillary, and hospital providers. Acts in an advisory capacity with the Legal Department with regard to the financial and legal impact of provider contract language requested. Reports on status of all contracting activities.
- Coordinates and assures proper notification to all relevant departments of any new contracts once they are executed.
- Assists in the development of standardized fee schedules and their implementation in the consultant provider community.
- Maintains and services existing institutional and specialty contracts as needed.
- Develops and generates appropriate reports on size, magnitude, cost effectiveness and comparative marketability of networks for internal and external customers.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Perform other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Significant experience (usually 7+ years) in managed care with 2-3 years strategic operational experience in network development.
- Expert knowledge of provider contracting/negotiations, provider relations and configuration, standards for managed care delivery, and cost containment programs.
- In-depth experience with regulated lines of business.
- Substantive knowledge of managed care policy and direction.
- Strong communication and negotiation skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: Louisville, KY, US
Other Locations: ,
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2013-05-21 00:00:00.0
Job ID: 1311821