Senior Provider Contract Specialist
Corewell Health
- Grand Rapids, MI
- Permanent
- Full-time
- Manages the contract development and negotiations process for provider networks initiatives. Enters/maintains current information in the internal contract repository and system contract database.
- Create and executive network development plans and deploy strategies to move providers to desired contract terms according to guidelines and standards. Provide effective oversight of contract implementation process ensuring all contracts are within required guidelines and financial parameters.
- Act as the principle contract negotiator for all assigned contracts. Manages contract review meetings to ensure delivery against objectives and contract budgets; develops regular reports on contract milestones and performance; and informs internal customers of activities and progress, through both verbal and written communications.
- Interface routinely with hospital, PHO, and PO leadership on an independent basis while understanding other political sensitivities of assigned groups.
- Work with and involve relevant stakeholders (internal customers) as needed in negotiation decisions impacting legal or regulatory requirements, contract standards, cost target and payment and pricing methodologies. Facilitate contract implementation process with the PIM team, including payment rates, PFP/PHO groupings, risk poll assignment, administration and other fees. Work collaboratively with PIM and other internal staff to find solutions to provider issues concerning payment and operation procedures, etc, when necessary.
- Creates a customer-focused, service-based approach to working with stakeholders which emphasizes the creation and cultivation of cross-organizational relationships.
- May represent contracting at external and Joint Operating Committee meetings. May oversee development and implementation of network expansion and individual physician recruitment within an assigned geographic area. May be requested to present and represent Provider Network Contracting at meeting with external constituencies.
- Provides mentoring to less experienced team members, and is accountable as a role model for customer service excellence.
- Required Bachelor's Degree or equivalent Bachelor's Degree in business administration, health care administration, psychology, finance, health and human services
- Preferred Master's Degree Masters Degree in business administration, health care administration, finance, health and human services
- 5 years of relevant experience Negotiating and managing contract lifecycles on behalf of either third party payers or health care providers Required
- 7 years of relevant experience Proven experience leading negotiations directly and independently or leading a provider contracting team in negotiations. Required
- Experience in finance or contract management and knowledge of CMS and commercial pricing practices and methodologies Required
- Experience working with legal staff Preferred
- Skills in best practices for contract negotiation tactics and strategies Preferred
- Working knowledge of anti-trust laws Preferred
- Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
- Waist to Waist > 5 lbs: Seldom up to 10 lbs
- Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
- Waist to Overhead > 5 lbs: Seldom up to 10 lbs
- Bilateral Carry > 5 lbs: Seldom up to 10 lbs
- Unilateral Carry > 5 lbs: Seldom up to 10 lbs
- Pushing Force > 5 lbs: Seldom up to 10 lbs
- Pulling Force > 5 lbs: Seldom up to 10 lbs
- Sitting: Frequently
- Standing: Occasionally
- Walking: Occasionally
- Forward Bend - Standing: Seldom
- Forward Bend - Sitting: Occasionally
- Trunk Rotation - Standing: Seldom
- Trunk Rotation - Sitting: Occasionally
- Reach - Above Shoulder: Seldom
- Reach - at Shoulder or Below: Seldom
- Handling: Occasionally
- Forceful Grip > 5 lbs: Seldom
- Forceful Pinch > 2 lbs: Seldom
- Finger/Hand Dexterity: Frequently