The Provider Contracting Executive is responsible for contracting relationships with physicians, physician groups, institutions and ancillary providers including the development of contracting strategies, coordination of analytical support, negotiation, and effective administration. They cultivate and maintain relationships with key providers and promote innovative products and reimbursement methodologies.
Maintains and expands the health care delivery system network by negotiating contracts and maintaining relationships with providers.
Cultivates relationships with providers that position the organization to meet its objectives relating to cost effectiveness, quality of care, enrollment growth, administrative efficiency, product positioning and profitability.
Monitors financial and utilization performance of contracts and develops plans to improve performance with the Health Care Services division.
Regularly meets with key provider leaders to review cost/utilization reports, prepares analysis, recommends strategies, researches problem issues and serves as the primary "client manager."
Develops and maintains new regional networks to support the introduction of new products, maintaining a high understanding of the health plan market pricing and communicates the strategic benefits to providers of participating in new networks and products.
Works collaboratively with the provider consultants and representatives to ensure that contracts are appropriately administered and that improvement plans are being managed.
Supports specific initiatives (based on potential cost savings and the impact on member care and providers) which will reduce our healthcare expenditures while still delivering the best care possible to our members.
Develops and manages risk arrangements including developing, arranging and maintaining pricing and accountable health system funding arrangements.
Develops long and short range contracting strategies for each delivery system assigned.
Strong understanding of managed care and accountable health system models and relationship to contracting strategy and reimbursement methodology.
Proven ability to build positive relationships and negotiate successfully with institutional, professional, and ancillary providers.
Demonstrated competency related to varying payment methodologies and value base contracting. (such as Pay for Quality/Performance, DRG, APC, ASC, Capitation, Fee for Service, RBRVS, Per Diem, Per Case)
Ability to analyze financial, quality, and utilization data and use to develop contracting strategies. Ability to organize and manage a portfolio of contracts.
Ability to work in high-pressure circumstances and effectively manage conflict and ambiguity. Senior Provider Contracting (requirements in addition to above)
Proficiency building relationships and negotiating successfully with large and complex market-leading institutional and professional providers.
Ability to independently and effectively communicate with high level executives internally and externally.
Normally to be proficient in the competencies listed below
The Provider Contracting Executive would have a Bachelor's Degree in healthcare, business or a related field and 5 years' experience in a healthcare industry provider contracting, relations, or analytical capacity or equivalent combination of education and experience.
The Provider Contracting Executive Senior would have a Bachelor's Degree in healthcare, business or a related field and 7 years' experience in a healthcare industry provider contracting, relations or analytical capacity or equivalent combination of education and experience.
Required Licenses, Certifications, Registration, Etc.
Valid driver's license.
The expected hiring range for a Provider Contracting Executive is $80,500 - $109,500 for a Provider Contracting Executive Senior is $97,500 - $132,000 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for the Provider Contracting Executive position is 10%. The bonus target for the Provider Contracting Executive Senior position is 15%.The current full salary range for the Provider Contracting Executive role is $76,000 - $123,500 and the Provider Contracting Executive Senior is $91,500 - $149,000. #LI-hybrid #LI-remote
Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:
medical, dental, and vision coverage for employees and their eligible family members
annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
paid time off varying by role and tenure in addition to 10 company holidays
up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
one-time furniture and equipment allowance for employees working from home
up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.