Behavioral Health Contract NegotiatorPrimary Location: Blue Bell, Pennsylvania
Additional Locations: PA-Blue Bell Apply
59993Fundamental Components: Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers. Manages contract performance in support of network quality, availability, and financial goals and strategies. Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities. Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit. Assists with the design, development, management, and or implementation of strategic network configurations, including integration activities. May optimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. Background Experience: Proven working knowledge of competitor strategies, complex contracting options, value based contracting, financial/contracting arrangements and regulatory requirements.
3-5 years related experience, proven and proficient negotiating skills.
Strong communication, critical thinking, problem resolution and interpersonal skills.
Bachelor’s Degree or equivalent combination of education and experience. Must
possess a successful track record negotiating behavioral health facility and
provider group contracts. *Must have understanding of multiple reimbursement
methodologies used in healthcare provider contracting *Contractual negotiation
experience with an understanding of behavioral health services and contract
language Additional Job Information: The
successful candidate will have the opportunity to work for one of the largest
and most successful companies in the healthcare industry, while creating
enhanced choices for our members as we work to transform behavioral health. The
position will include the chance to become involved with many different aspects
of the company's operations including Legal, Operations, health Services, and
Database Management, and it will provide the successful candidate with the
opportunity for career growth. Required Skills: General Business - Maximizing Work Practices, Leadership - Collaborating for Results, Sales - Negotiating Collaboratively Desired Skills: General Business - Applying Reasoned Judgment, General Business - Consulting for Solutions, Sales - Knowing Customers Functional Skills: Network Management - Contract negotiation, Network Management - Provider relations Technology Experience: Aetna Application - Enterprise Provider Database System, Aetna Application - Strategic Contracts Manager, Network - Network development Education: Audit - National Association Of Certified Fraud Examiners Potential Telework Position: Yes Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
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