Contract NegotiatorPrimary Location: Metairie, LA
Additional Locations: LA-Metairie Apply
67076Fundamental Components: Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small and large groups, 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. Preferred experience handling commercial and Medicare contract negotiations. Strong communication, critical thinking, problem resolution and interpersonal skills. Bachelor’s Degree or equivalent combination of education and experience. Additional Job Information: Knowledge of Medicare and commercial payment methodologies, i.e; surgical OP groupers, per diem, flat rate, case rate, fee schedules based on RBRVS.. Preferably knowledgeable on contracting and negotiating language and rates for ASCs, large physician groups, hospital based groups, home health, lab, DME, rehab, LTACs, hospice, free standing radiology, sleep centers, etc.. Strategic thinker that works collaboratively with other departments to execute competitive agreements with providers.. Proficient with Microsoft Office. Required Skills: General Business - Communicating for Impact Functional Skills: Network Management - Contract negotiation, Network Management - Physician recruiting - medical 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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