[Hiring] Senior Network Development Executive @Claritev

Role Description

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.

Qualifications

• Minimum Bachelor’s Degree in related or applicable field, or HS Diploma (or GED) and four (4) years of experience related to network development.
• Minimum 5 years of experience in provider contracting and network development, including contracting experience with physicians, physician groups, hospitals, and ancillary providers, or equivalent provider/payer experience.
• Knowledge of provider finance components including budgets, charge structures, reimbursement formulas, and healthcare finance.
• Knowledge of provider organizations and operations applicable to assigned focus area.
• Knowledge of the provider community and market dynamics, including interrelationships among hospitals, physicians, and ancillary services.
• Excellent written, verbal, and listening communication skills, along with strong business acumen, analytical, negotiation, organizational, strategic thinking, multitasking, and prioritization skills.
• Demonstrated success developing and negotiating complex financial rate structures and contract language.
• Strong project and priority management skills in fast-paced environments.
• Experience negotiating rate structures and contract language aligned with the Company’s business model while minimizing risk.
• Strong understanding of contract structures with experience minimizing non-standard language.
• Proven relationship-building skills with the ability to establish trust and credibility across all levels of the organization.
• Collaborative approach with experience working across teams and organizational boundaries.
• Strong internal and external customer relationship management skills.
• Understanding of provider and competitor structures, relationships, and market dynamics.
• Professional presence and effectiveness in in-person client interactions.
• Strong persuasion and influencing skills.
• Effective presentation and communication of the Company’s value proposition.
• Willingness and ability to travel, including overnight stays.
• Professional representation of the Company in all interactions.
• Proficiency with computer software, hardware, and peripherals applicable to the role.

Benefits

• 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.
• 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.