Provider Network & Ancillary Contract Representative

Amida Care is a Diversity, Equity, and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote, and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

This position is responsible for assisting the Assistant Director providing direction and focus in overseeing the managed care contract negotiations for ancillary services and high volume Provider relationships. She/he will work collaboratively with the Assistant Director of Provider Services to negotiate future managed non-acute care contracts; identify and implement best practices and share knowledge to enhance the service and technical quality. Work requires exercising considerable independent judgment and initiative in developing contract specifications, initial and ongoing provider relationships, contract monitoring and ensuring the achievement of contract administration objectives.

ESSENTIAL FUNCTIONS

Essential functions are job duties and responsibilities that must be performed to accomplish the purpose/ goals of the job.

• Develop, contract, maintain and enhance relationships with ancillary providers which serve as contractual work networks of care for members; foster growth of managed care products; and, enhance profitability of Amida Care.

• Oversees and develops ancillary provider recruitment strategy as necessary to meet State requirements.

• Provide continuous service and education to network providers.

• Represent provider needs within Amida Care, in the context of contractual, compliance, regulatory, credentialing, claims, provider files and, administrative policy and procedure issues.

• Develop, negotiate and monitor implementation of managed care contracts for Amida Care in all boroughs.

• Responsible for developing and retaining relationships with business leadership. Address incoming provider inquiries: identifies potential claims trends and follows-up with provider and internal departments to ensure that identified problems have been resolved.

• Contracting and provider service knowledge of various ancillary providers. Understands various contract terms, claims resolution, reimbursement methodologies and quality incentive plans.

• Maintain contract files and administer all pre- and post-contract execution actions and requirements including maintenance of tracking methodology to ensure follow up process in place for notification of tasks.

• Successfully execute all processes to support the Provider Directory and other pertinent reports. This includes, but is not limited to, modifications of records to assure appropriate support of business processes and all other activities in a timely manner.

• Conducts limited negotiations and drafts contract amendments.

• Serve as plan liaison for physician’s/physician groups in a specified geographical area. Will be main point of contact for all plan-related issues including contracting, billing and reimbursement. Responsibility for the resolution of all issues, including those identified by the provider, and those identified internally that have an impact on the physician

• Ensure provider data is entered in systems in alignment with contractual agreement.

MINIMUM JOB REQUIREMENTS

• Bachelor’s Degree in Health Care Administration or Business or, an equivalent combination of education and related work experience in health and/or managed care required.

• Five (5) years’ experience in health care.

• Three (3) years’ experience in provider/payor contracting.

• Demonstrate experience in developing contract types, fee arrangements and other contract terms.

• Demonstrate organizational and project management skills.

• Demonstrate experience in developing and recommending potential solutions to contract issues.

• Demonstrate proficiency with Microsoft Office (Word, Excel, Access and Outlook).

• Exhibit ability to read and communicate effectively in English.

• Exhibit strong verbal and communication skills.

• Exhibit ability to communicate in front of large and small groups.

• Bi-lingual Spanish a plus.

• Must be able to travel within assigned geographic area, including a possessing a reliable personal vehicle.

• Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.

• Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.

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