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Network Management & Contract Analyst (Hybrid) - 015203
Company | Excellus BCBS |
Address | Rochester, NY, United States |
Employment type | FULL_TIME |
Salary | |
Category | Insurance |
Expires | 2023-06-16 |
Posted at | 1 year ago |
Summary
- Effectively prepares and presents information, findings, and recommendations to internal and external stakeholders.
- Performs other functions as assigned by management.
- Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies.
- Serves as liaison with assigned stakeholders to identify and coordinate provider network contract and administration work items. Executes initiatives; tracks, forecasts and reports on progress including qualitative and quantitative measures.
- Responds to and resolves inquiries from providers and colleagues related to provider network contracting and administration. Leads issue resolution with internal and external stakeholders.
- Assist in the preparation of provider contracts, amendments, and communications.
- Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
- Establishes and maintains network adequacy for assigned provider types, regions and/or lines of business. Serves as provider network contracting and administration subject matter expert for assigned areas.
- Regular and reliable attendance is expected and required.
- Identifies, investigates, and analyzes issues and questions. Collects and interprets data and information to support provider network contracting and administration activities. Applies applicable contract terms, regulatory and legal requirements, and other information to produce accurate and actionable analysis.
- Engages in provider contract negotiations. Works routinely and directly with providers, clinical, and operational leadership.
- Maintains knowledge of relevant legislative and regulatory mandates to ensure compliance.
- Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
- Understanding of medical care delivery, industry trends, and regional market dynamics.
- Six (6) years of provider network reimbursement or related experience required. Or a Bachelor’s degree in Health Care Administration or relevant field.
- Demonstrated experience of provider reimbursement methodologies.
- Knowledge of health care products and services offered to members.
- Technical skills including modeling and financial analysis.
- Strong, persuasive, and effective verbal and written communication skills.
- Excellent problem-solving skills.
- Ability to draft, interpret and apply contractual language.
- Two (2) years of experience directly performing provider contracting or reimbursement analysis required.
- Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
- Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
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