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TX STAR+PLUS Contract Negotiator

Primary Location: Houston, TX
Additional Locations: TX-Baytown, TX-Champions, TX-Conroe, TX-El Campo, TX-Galveston, TX-Houston, TX-Lake Jackson, TX-League City, TX-Missouri City, TX-Pasadena, TX-Pearland, TX-Sugar Land, TX-The Woodlands
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Description:
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas STAR+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.

Negotiates, executes, conducts review and analysis, dispute resolution and/or settlement negotiations of contracts with group/system providers in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality, and financial goals and cost initiatives. Participates in specific medical cost initiatives. Travel is required with personal vehicle. Must have active and valid TX driver's license, reliable transportation and vehicle insurance. Routine travel to Houston office and other locations, per business needs.
  • HARRIS SERVICE AREA: Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller and Wharton counties.


Fundamental 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.
  • Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.


Additional Job Information:
  • Travel to the Dallas office may be required for onboarding, training and meetings.

At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas STAR+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.

Required Skills:
Benefits Management - Interacting with Medical Professionals, General Business - Communicating for Impact, Sales - Managing Competitive Networks

Desired Skills:
General Business - Communicating for Impact, Sales - Managing Competitive Networks, Sales - Negotiating Collaboratively

Functional Skills:
Network Management - Contract negotiation

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Potential Telework Position:
No

Percent of Travel Required:
10 - 25%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by 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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