NH Healthy Families · 1 week ago
Contract Negotiator
Massachusetts, United States
Full-time, Contract
Hybrid
Entry, Mid Level
$56K/yr - $101K/yr
2+ years expCentene is transforming the health of our communities, one person at a time. The Contract Negotiator will coordinate and negotiate agreements with healthcare providers, ensuring compliance with corporate and state guidelines while developing a robust provider network.
Financial ServicesHealth CareHealth InsuranceMedical
Responsibilities
Coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi specialty groups) and ancillary service agreements that are in accordance with corporate, health plan and State guidelines
Recruit and develop provider network plan for region and set of providers
Identify and initiate contact with potential providers
Negotiate contracts
Leads assigned negotiations (i.e., hospital, physician and ancillary) and ensure that negotiations result in the unit cost targets expected and meet the objectives of the company and approximate the State’s reimbursement to the provider
Facilitate and provide oversight to the provider set-up and contract configuration to ensure accurate claims adjudication
Evaluate and monitor providers’ performance standards and financial performance of contracts
Assist with and track credentialing activities
Facilitate the organization of provider focus groups
Coordinate with internal departments and contracted providers to implement and maintain contract compliance
May require up to 25% travel
Performs other duties as assigned
Complies with all policies and standards
Qualification
Required
Bachelor's degree in Healthcare Administration, Business Administration, Marketing, related field, or equivalent experience
Valid driver's license
Coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi specialty groups) and ancillary service agreements that are in accordance with corporate, health plan and State guidelines
Recruit and develop provider network plan for region and set of providers
Identify and initiate contact with potential providers
Negotiate contracts
Leads assigned negotiations (i.e., hospital, physician and ancillary) and ensure that negotiations result in the unit cost targets expected and meet the objectives of the company and approximate the State's reimbursement to the provider
Facilitate and provide oversight to the provider set-up and contract configuration to ensure accurate claims adjudication
Evaluate and monitor providers' performance standards and financial performance of contracts
Assist with and track credentialing activities
Facilitate the organization of provider focus groups
Coordinate with internal departments and contracted providers to implement and maintain contract compliance
May require up to 25% travel
Performs other duties as assigned
Complies with all policies and standards
Preferred
2+ years of contracting, provider relations or other related experience preferably in a healthcare, managed care, or insurance related environment
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
A flexible approach to work with remote, hybrid, field or office work schedules
Company
NH Healthy Families
NH Healthy Families is a managed care organization serving the needs of New Hampshire residents through the state Medicaid program and Ambetter Marketplace exchange product.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase