Summary:

As a professional within the network contracting and administration team, the incumbent will contribute to the development and maintenance of provider networks. This position is accountable for performing provider and network analysis, evaluating provider reimbursement, and negotiating provider contracts in accordance with corporate strategy. As such, the role requires a multifaceted understanding of provider types, applicable legal and regulatory requirements, pricing methodologies, industry and regional provider impacts & trends, provider reimbursement and related programs, and product lines.

Essential Accountabilities:

• Establishes and maintains network adequacy for assigned provider types, regions and/or lines of business. Serves as provider network contracting and administration subject matter expert for assigned areas.

• Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies.

• Identifies, investigates, and analyzes issues and questions. Collects and interprets data and information to support provider network contracting and administration activities. Applies applicable contract terms, regulatory and legal requirements, and other information to produce accurate and actionable analysis.

• Effectively prepares and presents information, findings, and recommendations to internal and external stakeholders.

• Serves as liaison with assigned stakeholders to identify and coordinate provider network contract and administration work items. Executes initiatives; tracks, forecasts and reports on progress including qualitative and quantitative measures.

• Engages in provider contract negotiations. Works routinely and directly with providers, clinical, and operational leadership.

• Assist in the preparation of provider contracts, amendments, and communications.

• Maintains knowledge of relevant legislative and regulatory mandates to ensure compliance.

• Responds to and resolves inquiries from providers and colleagues related to provider network contracting and administration. Leads issue resolution with internal and external stakeholders.

• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.

• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

• Regular and reliable attendance is expected and required.

• Performs other functions as assigned by management.

Minimum Qualifications:

• Six (6) years of provider network reimbursement or related experience required. Or a Bachelor’s degree in Health Care Administration or relevant field.

• Two (2) years of experience directly performing provider contracting or reimbursement analysis required.

• Demonstrated experience of provider reimbursement methodologies.

• Ability to draft, interpret and apply contractual language.

• Technical skills including modeling and financial analysis.

• Understanding of medical care delivery, industry trends, and regional market dynamics.

• Strong, persuasive, and effective verbal and written communication skills.

• Knowledge of health care products and services offered to members.

• Excellent problem-solving skills.

Physical Requirements:

• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.

• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

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One Mission. One Vision. One I.D.E.A. One you.

Together we can create a better I.D.E.A. for our communities.

At the Lifetime Healthcare Companies, we’re on a mission to make our communities healthier, and we can’t do it without you. We know diversity helps fuel our mission and that’s why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating our employees' experiences, skills, and perspectives, we take action toward greater health equity.

We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ+ people, people with disabilities, veterans, and other underrepresented groups to apply.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer