Provider Contracting Professional - Medicaid
DescriptionThe Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Provider Contracting Professional 2 communicates contract terms, payment structures, and reimbursement rates to providers within the Behavioral Health/Medicaid space. You will develop and grow positive, long-term relationships with physicians, providers, and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
2 - 5 years of experience in negotiating managed care contracts with physician, hospital and/or other provider contracts
At least 1 year of experience with Medicaid contracting
Experience in provider engagement and education
Proficiency in analyzing, understanding, and communicating the financial impact(s) of contract terms, payment structures, and reimbursement rates to providers
Excellent written and verbal communication skills
Ability to manage multiple priorities in a fast-paced environment
Proficiency in MS Office applications
Residency in the state of Oklahoma
Experience with Value Based Contracting
Experience working with Behavioral Health Medicaid contracts
Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Scheduled Weekly Hours40