JOB SUMMARYThe Senior Contracting Specialist oversees the development and management of insurance networks, focusing on improving affordability and quality outcomes while managing provider relationships and negotiation strategies in their specified region. This role is crucial for building and maintaining a strong network of healthcare providers, ensuring access to care for members, and optimizing network performance. Candidates should have experience working with providers in their specified region states.
ESSENTIAL DUTIES AND RESPONSIBILITIES - Manages contract negotiations with large physician groups and ancillary providers; conducting several negotiations simultaneously to meet growth demands
- Deep understanding and experience with all clinical specialties to ensure contract terms and conditions address the coding structures which are most impacted by negotiations
- Proactively builds relationships that nurture provider partnerships to support the local market strategy
- Initiates, nurtures, and maintains effective channels of communication with matrix partners including but not limited to, Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing
- Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position
- Identify and manage initiatives that improve total medical cost and quality; including renegotiation of existing agreements
- Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms
- Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities.
- Assists in resolving elevated provider service complaints; researching and negotiating with internal/external partners/customers to resolve complex and/or escalated issues.
- Manages key provider relationships and is accountable for critical interface with providers and business staff
- Coach and support newer team members on strategies and approaches to successful negotiations
- Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
- Partner with Regulatory Affairs to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity
- Performs other duties as assigned
QUALIFICATIONSTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
- Existing relationships with major health systems and large physician groups within the region is required
- Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
- Experience with Physician group and ancillary provider contracting and negotiations
- Experience negotiating delegated credentialing agreements
- Experience in developing and managing key provider relationships including senior executives
- Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
- Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models
- Team player with proven ability to develop strong working relationships within a fast-paced organization
- The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations
- Customer centric and interpersonal skills are required
EDUCATION and/or EXPERIENCE - Bachelor's degree or equivalent experience in related field, including 7+ years of work experience beyond degree within provider contracting and/or health insurance
WORK ENVIRONMENTThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this Job, the employee is regularly required to sit; use hands to handle or feel; talk; and hear.
- The employee is frequently required to reach with hands and arms.
- Specific vision abilities required by this job include close vision, color vision
- The noise level in the work environment is usually: Mild
- For this position the percentage of expected Travel is: 5-10% of the time
Perks & Benefits - Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)
- $0 copays and $0 deductibles (with completion of our Baseline Visit )
- Preventive and primary care built in
- Mental health support (Rula, Televero, Two Chairs, Recovery Unplugged)
- One-on-one care navigation
- Chronic condition programs (diabetes, weight, hypertension)
- Maternity and family planning support
- 24/7/365 Curative Telehealth
- Pharmacy benefits
- Comprehensive dental and vision coverage
- Employer-provided life and disability coverage with additional supplemental options
- Flexible spending accounts
- Flexible work options: remote and in-person opportunities
- Generous PTO policy plus 11 paid annual company holidays
- 401K for full-time employees
- Generous Up to 8-12 weeks paid parental leave, based on role eligibility.
