Network Contract Specialist

Job Summary:

This position will facilitate and lead negotiations between physicians and other healthcare professionals, ancillary providers, hospitals and Medrisk. Responsibilities may include developing, negotiating and implementing the network contracting arrangements. In addition, this position will be responsible for developing and maintaining effective relationships with the network decision makers.   Develops, and maintains provider/ancillary/facility special arrangement contracting, and the implementation associated with those contracts.  Additional responsibilities include the creation and review of financial utilization impact analysis for assigned specialties/territories.

Responsibilities:

• Prepares and maintains the provider negotiation materials and negotiates new contracts for physicians, other healthcare professionals, ancillary providers, and hospitals.  Directly negotiate new and existing special arrangement contracts.
• Prepares negotiation offers through financial and utilization reporting tools and works with the Legal Department to secure necessary approvals to ensure all contract offers are compliant with applicable regulations and company policies.
• Prepares and facilitates clean contract offer to provider/facility.
• Coordinates with the team members and other appropriate areas to effectively troubleshoot complex claim situations, contract disputes, executive, and client referrals.
• Functions as a liaison between the provider network and HCS to resolve issues, ensure quality, and facilitate the implementation process.
• Screens new provider prospects to determine compliance with business requirements and collects necessary documents and information to allow for clean contract handoff and accurate provider file set up.
• Responsible for facilitating the provider/facility contract welcome packet and termination process.
• Communicates contracted rate updates to provider/facilities.
• Develops a working knowledge of the provider/ancillary/facility strengths, weaknesses, and role within the communities, and makes recommendations relative to the development of negotiation strategies.  Develops and maintains relationships with health care organizations/professional associations within assigned territories.
• Responsible for the reporting of initial results and ongoing status updates to management.
• Updates and maintains recruitment reports and databases in order to provide status updates on negotiation progress in support of internal and external customers.
• Demonstrates knowledge, understanding, and conforms to the laws, regulations, and policies that pertain to the organization and the Workers’ Compensation and Personal Injury Protection lines of business.
• Perform other relevant tasks as assigned by management

Education/Experience:

• High School Diploma/GED required.
• Bachelor’s degree in business, finance, accounting, health administration preferred or relevant experience in lieu of degree.
• Requires a minimum of 5 years’ experience in the health insurance industry or related field.
• Requires a minimum of 3-5 years’ business experience in contract negotiation.

Knowledge:

• Knowledge of various Workers’ Compensation and Personal Injury Protection products strongly preferred.
• Requires general knowledge of physician/ancillary/facility reimbursement principles and practices.
• Requires knowledge of principals of health care contracting.
• Knowledge of products, Department of Banking and Insurance, Federal and State Regulations applicable to the Workers’ Compensation and Personal Injury Protection lines of business preferred.
• Requires strong knowledge of MS Office and related applications.

Skills and Abilities:

• Requires the ability to utilize a personal computer and applicable software.
• Must demonstrate strong negotiation skills with the demonstrated sales ability to convert prospect to contracted provider in addition to demonstrated persuasive skills
• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team. 
• Must demonstrate professional and ethical business practices, adherence to company standards.
• Proven time management skills are necessary. Must demonstrate the ability to manage multiple priorities [or tasks], deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required. 
• Demonstrates flexibility and adapts to multiple responsibilities encompassing multiple areas within the organization.
• Must demonstrate the ability to effectively present information and respond to questions from groups of managers, clients, and customers.
• Must be detail oriented
• Proven ability to influence without authority.