Sr Network Development Executive
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 network-based solutions by negotiating optimal reimbursement rates and drafting contracts for network and non-network providers to support 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.
In addition, this position is responsible for working with management in the aggressive execution of regional strategies based on market trends and client expectations, as well as continuous evaluation of assigned territory penetration and discounts. This role may support other areas such as Payment Integrity and Analytics-Based Services.
Key Responsibilities
- Assist management in the identification and development of contracting priorities for assigned territory to support Network Development provider contracting initiatives
- 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
- Foster and maintain superior provider relationships, including management of the business relationship with large, complex providers
- Respond to provider questions, issues, and problems that have been appropriately escalated and produce a solution
- Conduct complex internal audits and reviews of existing provider relationships and supporting documentation to resolve internal or external inquiries
- Function as provider-specific expert by identifying, understanding, and documenting strategic business needs and market strategies
- Maintain, and preferably exceed, contracting production and quality standards consistent with established regional goals
- Prepare analyses, reports, and presentations by collecting, analyzing, and summarizing information and trends
- Monitor, compare, and contrast market competitive information to develop and initiate growth strategies and assess network adequacy and marketability
- Serve as mentor to less experienced Provider Contractors through ongoing instruction, coaching, modeling, and counseling
- Work with Sales and Account Management to respond to and anticipate access requirements and network-related performance guarantees
- Partner with HCE to conduct financial analyses and monitoring of market trends to identify, develop, and implement competitive reimbursement strategies
- Collaborate, coordinate, and communicate across disciplines and departments
- Develop and maintain positive relationships at all levels within the organization and communicate provider needs to applicable process owners
- Ensure compliance with established policies and procedures and regulatory requirements (including but not limited to HIPAA)
- Complete mandatory training requirements, including Human Resources, product orientation, and contracting tools and resources
- Demonstrate Company’s Core Competencies and values
- Perform other duties as assigned
Job Scope
The incumbent is considered to be a senior staff professional who applies comprehensive knowledge of principles, practices, and procedures related to the completion of complex or difficult negotiation and maintenance of provider network contracts.
This role works independently and has substantial latitude for unreviewed action or discretion and may have authorization to act outside standardized procedures. The incumbent may assist less experienced Provider Contractors in resolving complex issues and may act in a liaison capacity with other departments.
This position does not directly manage others but may provide project or work direction to less experienced team members. The role may require overnight travel to meet with providers in assigned geographic areas and/or attend company-sponsored meetings and events.
The incumbent will possess the skills necessary to strategize, construct, and negotiate complex financial rate structures and contract language and demonstrate successful negotiations requiring this skill set.
Qualifications
Job Requirements
- Minimum Bachelor’s Degree in related or applicable field, or HS Diploma (or GED) and four (4) years’ experience related to network development
- Minimum 5 years experience in provider contracting and network development, including contracting experience with physicians, physician groups, hospitals, and ancillaries, or equivalent provider/payer experience
- Knowledge of provider finance components including budget, charge structure, reimbursement formulas, and healthcare finance
- Knowledge of provider organizations and operations applicable to assigned focus
- Knowledge of the provider community and market dynamics, including interrelationships between hospitals, physicians, and ancillary services
- Excellent communication (written, verbal, and listening), business acumen, analytical, negotiation, organization, strategic, multitasking, and prioritization skills
- Ability to strategize, construct, and negotiate complex financial rate structures and contract language
- Ability to manage multiple competing priorities
- Ability to negotiate rate structures and contract language aligned with the Company’s business model while limiting risk
- Ability to minimize non-standard language through strong understanding of contract structures
- Ability to build trust and credibility across all levels of the organization
- Ability to work collaboratively across teams and organizational boundaries
- Ability to build relationships with internal and external customers
- Ability to understand provider and competitor structures and relationships
- Ability to manage in-person client interactions professionally
- Ability to persuade and influence
- Ability to effectively communicate the Company’s value proposition
- Ability to travel, including overnight stays
- Ability to present the Company in a professional manner
- Ability to use computer software, hardware, and peripherals applicable to the role
Additional Information
Please note, due to the exposure of PHI sensitive data — this role is considered to be a High Risk Role.
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
- Life insurance
- Short and long-term disability
- Paid Parental Leave
- 401(k) + match
- 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
- 10 paid company holidays
- Tuition reimbursement
- 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.
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