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Five (5) years of experience working with financial analysis supporting managed care contracting with providers including but not limited to hospitals, professionals ranging from large medical groups to solo practitioners, mental health practitioners, ASCs, skill nursing facilities, renal dialysis facilities, home health and DME. Current working knowledge of all aspects of a provider contract.
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Demonstrated or equivalent experience in leading all aspects of provider network activities, including network development, value based contracting strategies and negotiations, and provider servicing and relations which will facilitate the creation and maintenance of a high performing, accountable and engaged provider network.
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Providing guidance and oversight of Provider Contracting and Strategic Relationships. The Vice President, Contracting, under the direction of the Vice President, Provider Experience and in close partnership with Finance and Actuarial Services, is responsible for the overall development and management of contracting strategies, compliance and Provider oriented projects, initiatives and data analysis.
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Law degree; at least 8-10 years corporate legal department or law firm experience with a demonstrated background in medical provider contracting and the health care managed care/insurance industry.
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Manage negotiation, operation, and administration of liaison activities associated with healthcare provider contracting for the TriWest Veteran Administration (VA) Community Care Network (CCN) for the state of New Mexico.
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This position will also coordinate with: Compliance & Quality staff on the re-credentialing process; with Provider Contracting staff for contracting issues or concerns; and will periodically assist the Claims staff with auditing and troubleshooting of provider data to ensure proper claims adjudication.
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Experience working in healthcare provider analytics related to revenue modeling, managed care contracting, population management, case management, clinical or financial decision support required.
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Experience in analyzing and modeling provider contracts involving various current rate methodologies: MS-DRG, APC, CPT, Capitation, Fee-for-Service, RBRVS, Per Diem, Per Case and Percent of Charges; and at a minimum, an understanding of performance/risk-based payment concepts and structure.
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Be the "one touch resolution" for Provider and Member inquiries related to but not limited to Utilization Management, Claims, Eligibility, Contracting, and Directory validation for assigned IPA(s.
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IES is a national provider of industrial products and infrastructure services to a variety of end markets, including electrical, mechanical and communications contracting solutions for the commercial, industrial, residential and renewable energy markets.
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The Regional Vice President will also provide executive leadership to the Provider Contracting, Provider Education and Provider Engagement in support of Humana's Commercial, Medicare, and Medicaid lines of business.
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Develop and deliver provider education for participant facilities and individual physicians, in compliance with CCN program requirements, and conduct research into claims, referral and authorization, and other operational issues related to provider contracting and networking.
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340B contract pharmacy models, contracting and operational support, knowledge of HRSA and current landscape of legal and regulatory challenges to 340B pharmacy programs. Familiarity with infusion provider/pharmacy relationships, models and associated regulatory challenges (e.g., provider models, AICs, home infusion, RN networks/licensure.
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Projects range from performance contracting, energy efficiency retrofit, and backup/supplemental power distribution generator equipment emplacement. About UsPowerSecure, a Southern Company subsidiary, is a leading provider of innovative energy solutions to electric utilities and their industrial, institutional, and commercial customers.
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Gene therapy and Chimeric antigen receptor T-cell therapy (CAR-T therapy) provider contracting services, an expansion of our stem cell transplant network contracting capabilities that offers financial relief and patient access for this novel, emerging cellular therapy.
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