What are the responsibilities and job description for the Healthcare Contracting Director position at Curative?
Remote with occasional travel (5-10%)
Existing relationships with Major Health Systems and Large Physician Groups across Georgia required.
7 years of experience with health plans and provider organizations.
Duties And Responsibilities
- Manages contract negotiations with Major Health System and 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 manages 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
Requirements
