Recruit physician, hospital and ancillary service providers to sign network participation agreements that are in accordance with Corporate, health plan and State guidelines. Ensure that all necessary documentation and information are included.
Recruit and develop network for a region and set of providers
Lead assigned recruitments (i.e., physician, hospital and ancillary) and ensure they result in complete and accurate standard contracts that meet objectives
Facilitate and oversee to the provider set-up and contract configuration to ensure accurate claims adjudication
Initiate contact and identify potential providers by geographic and specialty needs and update database
Coordinate with internal departments and contracted providers to implement and maintain contract compliance
Highly qualified candidate will have a combination of the following attributes:
Lead facility, ancillary, and physician contract and network development activitiesConduct contract and pricing audits, network disruption analysis, what-if analysis and primary and secondary research
Manage provider relationships and solve problems through provider communicationsCommunicate with internal parties to resolve provider issues (claim disputes)
Utilize proprietary and third party systems (Salesforce, Emptoris, Xcelys, Microsoft Office)
Proactively identify and solve problems with limited supervisionRelevant experience whether contracting specific or other healthcare sector areas
Bachelor’s degree in Healthcare Administration, Business Administration, Marketing, Finance, related field, or equivalent experience. 2+ years of contracting, contract analysis, provider relations, or provider experience in a hospital or physician’s office or group setting. Familiarity with State and/or Federal health care programs preferred (Medicaid, Medicare).
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
TITLE: Contract Negotiator II
LOCATION: Houston, Texas
COMPANY: Business Dev & Sales
POSITION TYPE: Both