Healthcare Contracting Director- Georgia
Healthcare Contracting Director- Georgia
Posted on :
06-04-2025
Employer Active
1 Vacancy
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Job Description
Remote with occasional travel 510
Existing relationships with Major Health Systems and Large Physician Groups across Georgia required.
7 years of experience with health plans and provider organizations.
Duties And Responsibilities
- Manages contract negotiations with Major Health System and large physician groups and ancillary providers; conducting several negotiations simultaneously to meet growth demands
- Deep understanding and experience with all clinical specialties to ensure contract terms and conditions address the coding structures which are most impacted by negotiations
- Proactively builds relationships that nurture provider partnerships to support the local market strategy
- Initiates nurtures and maintains effective channels of communication with matrix partners including but not limited to Claims Medical Management Credentialing Legal Medical Economics Compliance Sales and Marketing
- Responsible for meeting unit cost targets while preserving an adequate network to achieve and maintain competitive position
- Identify and manages initiatives that improve total medical cost and quality; including renegotiation of existing agreements
- Prepares analyzes reviews and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms
- Collaborates crossfunctionally to manage provider compensation and pricing development activities submission of contractual information and the review analysis of reports as part of negotiation and reimbursement modeling activities.
- Assists in resolving elevated provider service complaints; researching and negotiating with internal/external partners/customers to resolve complex and/or escalated issues.
- Manages key provider relationships and is accountable for critical interface with providers and business staff
- Coach and support newer team members on strategies and approaches to successful negotiations
- Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape
- Partner with Regulatory Affairs to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity
Requirements
- Must have current Georgia hospital contracting experience
- Bachelors degree or equivalent experience in related field including 7 years of work experience beyond degree within provider contracting and/or health insurance
- Superior problem solving decisionmaking negotiating skills contract language and financial acumen
- Experience with complex Hospital / Health Systems Large Physician Groups and Ancillary provider contracting and negotiations
- Experience negotiating delegated credentialing agreements
- Experience in developing and managing key provider relationships including senior executives
- Demonstrated experience in seeking out building and nurturing strong external relationships with provider partners
- Intimate understanding and experience with larger more complex integrated delivery systems managed care and provider business models
- Team player with proven ability to develop strong working relationships within a fast paced organization
- The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations
- Customer centric and interpersonal skills are required
Required Experience:
Director
Employment Type
Full-Time
Key Skills
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