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Senior Provider Relations and Network Development Administrator Loc: Denver, CO


2017-06-23 12:20:48
Job Type: Full Time only
Budget $: 100,000 - 200,000

  • Develop and maintain effective multifaceted and strategic provider networks, with complex payment methodologies and alternate funding arrangements.
  • Engage providers to promote the concept and understanding of patient engagement adherence, quality improvement and cost savings programs.
  • Lead negotiation and implementation of complex, multifaceted provider contracts.
  • Complete negotiations within pre planned reimbursement targets and ensure successful implementation.
  • Serve as the main point of contact for the provider and coordinate all interactions with assigned provider accounts.
  • Build and maintain positive relationships.
  • Develop and execute ongoing account management and service strategies to meet corporate strategic/financial objectives.
  • Utilize consultative skills, industry knowledge, and product knowledge to foster a collaborative approach to quality care, network stability and cost containment.
  • Provide input and drive innovative development of payment methodologies and provider engagement strategies.
  • Collaborate with the Director of Provider Network Development to develop communication goals, strategies, and plans.
  • Responsible for market intelligence oversight, assuring it is being gathered and timely reported, as well as using results to the Companys benefit in contract negotiations.
  • Responsible for proactive collaboration with other internal departments on resolution of escalated or complex provider network issues, pricing, complaints, grievances or risks.
  • Engage with the efforts of the network reimbursement/analytics resources to ensure reimbursement is properly maintained and managed; oversight to ensure accurate implementation of complex contracts with hospitals and other key providers and/or vendors.

You Have:

  • A Bachelors Degree in Business, Finance or a related field; or a minimum of 5 years provider contracting experience to include hospital contracting
  • A minimum of 3 years progressive contracting experience utilizing financial models and analysis in negotiating complex hospital contracting methodologies with providers
  • A comprehensive, working knowledge of managed care principles, including risk contracting and value-based contracting
  • Experience with reimbursement methodologies such as Medicaid capitations/ alternative payment methodologies, Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
  • A solid team player with a Passion for living and promoting mission, vision and core values
  • Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others


Key Skills: