Job details
Job type full-time
Full job description
Verity healthnet
Provider contracting director
Objective:
Responsible for network development and management along with servicing for the louisiana geographic areaThe ideal candidate will possess experience in recruiting and managing provider networks along with negotiating, reviewing and amending contractsThis experience will include thorough knowledge of contracting with physicians, physician groups and ancillary providers using various payment methodologiesIdeally, the candidate will possess a very high level of business acumen and the ability to exhibit it both internally and externally to a wide variety of audiencesInnovation, independence and confidence are key competencies that need to be exhibited.
Essential job functions:
Negotiates and executes all contracts with physician and ancillary providers, while ensuring that all contracts are procured in accordance with verity’s processes and standards.
Understands industry standard provider reimbursement strategies, methodology, and market assessments; can speak to such topics in contract negotiation with providers.
Recruits targeted providers for participation within the verity networksAddresses and adjusts recruitment efforts in designated geographic areas in consideration of marketing needs and member access.
Actively pursues opportunities within the assigned local market (i.e., network expansion opportunities, utilization, etc.) and assesses market trends to drive initiatives which enhance verity`s market position.
Prioritizes and adjusts daily contracting initiatives and requests based on urgency and potential for claims disruption.
Develops and maintains positive relationships with network providers and responds timely to issues that arise.
Coordinates and manages the approval process of non-standard reimbursement arrangements.
Collaborates with all teams including operations, account management, analytics and sales to implement new structures and help manage the total cost of healthcare.
Exercise appropriate judgment in referring atypical, significant, or recurring problems to management for further review and action plan.
Ensure provider files and communications are properly maintained and recorded for reference.
Perform other duties and special projects as assigned in a timely and efficient manner.
Education and experience
3-5 years of medical network provider contracting, contract negotiations, and provider relations is required
Bachelor’s degree in business, healthcare policy, public health, or related field
Knowledge of cms fee schedule methodology is required
Knowledge of physician billing practices is required
Strong analytical and problem-solving skills
Individual must be achievement oriented with excellent written and oral skills
Must be well organized and process oriented
Excellent communication and organizational skills are required
Project management skills are a plus
Proficient in microsoft, excel and access databases is required
Working knowledge of value based and aco contracting is preferred
Working knowledge of medicaid and medicare contracting is preferred
This is a full-time position
Office location: baton rouge, louisiana
Remote work availability: this position is in-office with minimal travel required.
Travel: 10% travel may be required to meet with high priority providers identified by strategic initiatives.
