Manager, Provider ContractingPrimary Location: Downers Grove, IL
Additional Locations: IL-Downers Grove Apply
- Negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.
- Manages contract performance and supports the development and implementation of value based contract relationships in support of business strategies.
- Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
- Accountable for cost arrangements within defined groups.
- Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
- Responsible for identifying and managing cost issues and initiating appropriate cost saving initiatives and/or settlement activities.
- Serves as SME for less experienced team members and internal partners.
- 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 and integration activities.
- May optimize interaction with assigned providers and internal business partners to manage relationships to 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.
- Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.
- 5-7 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with individual or complex provider systems or groups.
- Strong communication, critical thinking, problem resolution and interpersonal skills.
- Bachelor’s Degree or equivalent combination of education and experience.
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