Provider Contracting Representative
At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple – we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external – driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!
JOB SUMMARY
This position is responsible for identifying and evaluating opportunities in support of MultiPlan’s Network-Based Solutions by negotiating optimal reimbursement rates, and drafting contracts for Network and non-network providers to support MultiPlan’s commercial and government products. This activity will ensure patient access to the highest quality, cost-effective providers of healthcare services in accordance with applicable regulations and the Company’s policies, practices and procedures. This role may support other areas such as MultiPlan’s Payment Integrity and Analytics-Based Services.
COMPENSATION
The salary range for this position is $75k-85k annually . Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.
JOB DUTIES
1. Assist management in the identification and development of contracting priorities for assigned territory to support Network Development provider contracting initiatives.
2. Negotiate provider contracts to support penetration and discount objectives relative to competitive market trends and client expectations through comprehensive, aggressive execution of region specific contracting goals derived from national and regional objectives related to penetration and discount objectives, and improved contractual terms.
3. Foster and maintain superior provider relationships including management of the business relationship with assigned providers. Respond to provider questions, issues, and problems that have been appropriately escalated and produce a solution.
4. May assist in managing relationships with leased networks. May also assist in managing client/payor relationships through various commercial and government initiatives.
5. Maintain, and preferably exceed, contracting production and quality standards consistent with established national and regional goals.
6. Prepare analyses, reports and presentations by collecting, analyzing, and summarizing information and trends.
7. Partner with HCE to conduct financial analyses and monitoring of market trends to identify, develop, and implement competitive reimbursement.
8. Monitor, compare and contrast market competitive information to develop and initiate growth strategies by assisting in development of action plans to assess network adequacy and regional competitiveness.
9. Please note, due to the exposure of PHI sensitive data — this role is considered to be a High Risk Role.
10. May serve as mentor to less experienced Provider Contractors through on-going instruction, coaching, modeling, and counseling aimed at developing the type of skills and behaviors that will result in successful resolution of provider contracting. Share provider contracting insights and information with less experienced contractors.
11. Work with Sales and Account Management to respond to and anticipate access requirements and network related performance guarantees.
12. Comply with mandatory training programs requirements, including Human Resources, product orientation and contracting tools and resources.
13. Ensure compliance with established policies and procedures, regulatory requirements, and mandatory training requirements (such as but not limited to HIPAA, integrity, product orientation, and contracting tools/resources).
14. Collaborate, coordinate, and communicate across disciplines and departments. Develop and maintain positive relationships at all levels within the organization and identify and communicate provider needs to the applicable process owners
15. Demonstrate Company’s Core Competencies and values held within.
16. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary. Qualifications
JOB REQUIREMENTS
* Minimum Bachelor’s Degree in applicable field, or HS Diploma (or GED) and four (4) years of experience related to network development
* Minimum 2 years experience in provider contracting and network development, or equivalent provider/payer experience, with some experience successfully negotiating complex financial structures and contract language.
* Required licensures, professional certifications, and/or Board certifications as applicable
* Knowledge and understanding of provider finance components including budget, charge structure, reimbursement formulas and healthcare finance
* Knowledge of provider organizations and operations applicable to assigned focus
* Communication (written, verbal and listening), business acumen, analytical, negotiation, organization, strategic, multitasking and prioritization skills
* Ability to demonstrate successful negotiations by possessing skills necessary to strategize, construct and negotiate complex financial rate structures and contract language.
* Ability to manage multiple competing priorities.
* Ability to understand and apply contract language of the Company and customer in order to minimize non-standard language changes
* Ability to effectively negotiate rate structures and contract language that is compatible with the Company’s business model while limiting risk to the Company and its clients
* Ability to minimize non-standard language by thoroughly understanding our contracts is a must
* Ability to understand relationships and structures of providers and competitors
* Ability to be comfortable with and to manage in-person client interface
* Ability to elicit trust and credibility with all levels of the organization
* Ability to effectively communicate the MultiPlan Value Proposition.
* Ability to work comfortably and routinely as part of a team and to cooperate across organizational boundaries
* Ability to build relationships with internal and external customers
BENEFITS
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
- Medical, dental and vision coverage with low deductible & copay
- Short and long-term disability
- Employee Stock Purchase Plan
- Generous Paid Time Off – accrued based on years of service
- WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
- Flexible Spending Account
- Employee Assistance Program
- Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits.
EEO STATEMENT
Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here.
APPLICATION DEADLINE
We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.
#LI-KB1
