Manager, Provider Contract Negotiation (Georgia)
$54,300–$119,340 year
On-siteAtlanta, Georgia, United States or Decatur, Georgia, United States
Job Summary
Evaluate provider data using internal tools to drive development and implementation of value-based contract relationships. Recruit providers to ensure attainment of network expansion and adequacy targets while managing cost arrangements within defined groups. Collaborate cross-functionally to manage provider compensation, pricing development, and reimbursement modeling activities. Identify and manage cost issues to execute significant cost saving initiatives and optimize interactions with assigned providers. Resolve escalated issues related to claims payment, contract interpretation, and demographic information accuracy. Represent the company with high visibility constituents including customers and community groups. Manage provider network strategic plans to achieve contracting targets and meet state contract and product requirements.
Required Qualifications
- 5+ years experience in a provider relations, contracting or managed care environment
- Knowledge of the managed care industry and practices, as well as a strong understanding of strategies, practices, and financial/contracting arrangements
- Must possess critical thinking, problem resolution, organizational and interpersonal skills
- Highly organized and self-driven
- Must reside in Georgia and able to drive into the Atlanta office location 1x per month
Desired Qualifications
- Ability to forge meaningful, long-lasting relationships with providers
- Physician, Ancillary and/or Commercial experience
- Knowledge of Medicare programs and related subject matter
- Bachelor's degree and relevant training or work experience
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