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Provider Contracting Specialist (REMOTE) ID-8415

Job Description

Resp & Qualifications

Candidate must reside in the CareFirst service area (MD, DC & VA)

PURPOSE:
This role is responsible for the building, management, oversight and negotiation of Institutional, Ancillary, Vendor, Dental and Professional contracts as well as the contracting of more complex high-performance provider networks. Performs duties to coordinate and support all types of provider contracting in accordance with guidelines in order to maintain and enhance the provider network and to meet accessibility, quality and financial goals.

ESSENTIAL FUNCTIONS:


QUALIFICATIONS:

Education Level: Bachelor's Degree, Business, Finance, Health Care Administration or related discipline OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 2 years healthcare, business- or job-related field. 1 year experience in contracting, provider recruitment and/or provider relations

Preferred Qualifications:
  • Master's degree in Business or Health Care Administration

Knowledge, Skills and Abilities (KSAs)
  • Deep understanding of multiple reimbursement methodologies used in healthcare provider contracting,
  • Proven ability to build strong collaborative business relationships.
  • Understanding of contractual documents and ability to effectively communicate terms to providers.
  • Working knowledge of provider community, market and its underlying financial dynamics.
  • Ability to function as a subject matter expert for assigned networks; ability to learn and use electronic contract management system.
  • Effective negotiation skills.
  • Superior PC skills, including financial analysis and modeling.
  • Working knowledge of provider community, market and its underlying financial dynamics.
  • Working knowledge of health care financial matters and third-party payment methodologies.
  • Effective interpersonal skills in order to lead project teams towards goal attainment and ability to work independently and as part of a team.
  • Effective time and project management skills to be able to plan and monitor activities to ensure achievement of organizational goals., Advanced
  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
    Salary Range: $62,856 - $124,839

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
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