Provider Contract Specialist (Medicare Advantage/Managed Medicaid)

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. JOB ROLES AND RESPONSIBILITIES: 1. Negotiate provider contracts to support penetration and discount objectives relative to competitive market tends 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. 2. Identify and successfully recruit providers to meet federal, state and/or local government Network Adequacy standards for member access to care for MultiPlan government clients 3. Foster and maintain superior provider relationships including day-to-day 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. Maintain, and preferably exceed, contracting production and quality standards consistent with established regional goals. 5. Prepare analyses, reports and presentations by collecting, analyzing, and summarizing information and trends. 6. Partner with HCE to conduct financial analyses and monitoring of market trends to identify, develop, and implement competitive reimbursement. 7. Please note, due to the exposure of PHI sensitive data - this role is considered to be a High-Risk Role. 8. Work with Sales and Accounts Management Peers to respond to and anticipate access requirements and network related performance guarantees. Use information derived from Requests for Proposals (RFP), Statement of Work (SOW) and other business opportunities to assess network adequacy and competitiveness in region. 9. Comply with mandatory training programs requirements, including Human Resources, product orientation and contracting tools and resources. 10. Ensure compliance with established policies and procedures and with regulatory requirements (such as but not limited to HIPAA, integrity, product orientation, and contracting tools/resources). 11. 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. 12. Demonstrate Company's Core Competencies and values held within. 13. 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. JOB SCOPE: The incumbent works under general supervision in applying a fundamental knowledge of principles, practices, and procedures related to the negotiation and maintenance of provider network contracts. This job is considered to be the entry level job into the Provider Contractor job family. An incumbent follows established procedures and confers with their supervisor to obtain approval and authorization to act outside the standardized procedures. More complex issues are referred to their supervisor for resolution. The work is varied and may be somewhat difficult in character and nature which requires the ability to evaluate the situation and provide options for resolution. An incumbent may be called on to work with more experienced Provider Contractors on a project or team basis. The job may require overnight travel to meet with providers in assigned geographical or areas of responsibility and/or travel to company sponsored meetings and events. The incumbent will work to develop the skills necessary to strategize construct and negotiate complex financial rate structures and contract language, to demonstrate successful recruitment and negotiations of providers to MultiPlan's commercial and government networks. Apply to this job Apply tot his job Apply To this Job