Senior Provider Contracting Coordinator (Hybrid)

Resp & Qualifications

PURPOSE:
This role is responsible for the building, management, oversight and negotiation of open negotiation notices (ONNs) received from non-participating providers as part of the No Surprises Act (NSA) Independent Dispute Resolution (IDR) process. Additionally, identifies non-participating providers that may be receptive to participating with CareFirst. Performs duties to coordinate and support ONN process and, as appropriate, work with Provider Contracting to encourage the non-participating provider to enter into a participating provider agreement with CareFirst.

ESSENTIAL FUNCTIONS:

• Successfully negotiates cost effective ONNS with non-par providers under the NSA IDR process that is consistent with the CareFirst Network strategy. Work closely Network Contracting identifying providers who my be willing to participate with CareFirst. Negotiate competitive and complex contracts in focused regions that will produce savings to clients. Ensures the economic details in the ONN offers meet the need of key stakeholders. Manages the ONN offer process and works with the Regulatory Operations Manager and Network Contracting to develop strategies and methodologies for negotiations of ONN and contracting with the provider. This includes negotiations, credentialing, financial quantification, network impacts, qualification and competitive analyses, implementation and monitoring of all contracts.
• Track ONN negotiation efforts, including Develop business cases and present findings to Senior Management to support reimbursement and contracting initiatives through statistical analysis, cost/benefit modeling and analysis. Develop and present business cases to support changes in network strategies including rates, payment methodologies and network configuration. Upon approval, develop and implement the network by sending out RFIs, establishing periodic financial targets, provider criteria for participation, contracts and amendments, renegotiate and manage targeted networks or institutions and gain consensus with other internal areas affected by network changes.
• Provide ongoing network management support to the Regulatory Operations Manager, Networks Management and senior management, on request and as needed. Assists n the activities of contract professionals in review and preparation of contract documents, the facilitation of training and mentoring and leads team on complex and difficult contracting activities including but not limited to being the focal point for all legal and legislative issues with expert working knowledge of all contracting environments.
• Develop contracts in coordination with the Legal Department for any changes to standard contract templates. Work with Legal to develop and review any proposed language changes discussed with a provider. Ensure compliance with jurisdictional regulatory requirements and quality monitoring organizations (NCQA).
• Improves NSA knowledge and other appropriate regulatory investigation job knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies.
• Improves NSA knowledge and other appropriate regulatory investigation job knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Business, Healthcare Administration, or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 5 years contracting negotiation, healthcare, or related experience/industry.

Preferred Qualifications:

• Understanding of a rate regulated versus non-rate regulated market.
• Working knowledge of provider community and market and its underlying financial dynamics. Working Knowledge of Salesforce.

Knowledge, Skills and Abilities (KSAs)

• Strong interpersonal skills. Ability to work independently, as well as a member of a team.
• Strong critical reasoning skills in decision-making, planning and organizing.
• Advanced understanding of contractual documents.
• Advanced understanding of the healthcare field and various regulatory agencies.
• Indepth knowledge of the NSA IDR Process.
• Subject Matter Expert (SME) for assigned networks; proficient in electronic contract management system.
• Deep understanding of t of contractual documents and ability to effectively communicate terms to providers.
• Effective time and project management skills to be able to plan and monitor activities to ensure achievement of organizational goals.
• Must possess the ability to problem solve and think strategically.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $56,448 - $112,112

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

IDR Expenses

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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