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AmeriHealth Caritas · 2 hours ago

Network Contractor Provider Network Management - Exchange product

Baton Rouge, LA

Full-time, Contract

Hybrid

Mid Level

3+ years exp

AmeriHealth Caritas is a mission-driven organization with over 30 years of experience in delivering comprehensive healthcare solutions. They are seeking a Network Contractor to manage provider contracting and ensure network adequacy while supporting provider satisfaction and compliance with regulations.

Health CareInformation Technology

H1B Sponsor Likely

Responsibilities

Supports network development strategy

Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication

Responsible for negotiating contracts to execute on network strategy and ensure an adequate, compliant and marketable network

Responsible for negotiating Single Case Agreements (SCA) rates and converting SCA providers to contracted

Responsible for recruiting and contracting providers based on identified network adequacy gaps (high complexity)

Ensures all contracts are negotiated to be compliant with Federal and State rules, regulations, policies and procedures and follow all departmental policies

Ensures contracts are supportive of Plan quality initiatives such as HEDIS, CAHPS and NCQA/URAC

Negotiates contracts to support management of provider satisfaction

Contractors will work with Corporate Provider Network Management to manage the annual contracting schedule as well as supplement the network as new providers are available or needed

Payment/fee schedule SME’s to develop resources in complex specialties i.e. FQHCs, BH, anesthesia etc. These SMEs will be available to AEs when needed for support of claims resolution

General Operational Knowledge related to provider satisfaction, education and communication with a fundamental understanding of operational items such as claims, payment integrity, provider data, credentialing, appeals disputes etc

Negotiates provider contracts consistent with claim payment methodologies

Augments and modifies the existing provider network to accommodate new products or clients as necessary

Reviews contract language and collaborates with legal to ensure best contract terms

Support contracting for multiple product lines, including Exchange, DSNP

Lead negotiator of Value Based Contracting in conjunction with AE

Qualification

Contract negotiationProvider network managementReimbursement methodologiesFinancial acumenDifficult conversations

Required

Three or more years Account Executive experience

Financial Acumen

Ability to have difficult conversations

1+ year contract negotiation experience

Understanding of reimbursement methodologies to include risk or Value Based contracting

Preferred

Bachelor's Degree preferred

Benefits

Flexible work solutions including remote options

Hybrid work schedules

Competitive pay

Paid time off including holidays and volunteer events

Health insurance coverage for you and your dependents on Day 1

401(k)

Tuition reimbursement

And more.

Company

AmeriHealth Caritas

Glassdoor3.4

AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.

Founded in 1982

Philadelphia, Pennsylvania, USA

10001+ employees

http://www.amerihealthcaritas.com

H1B Sponsorship

AmeriHealth Caritas has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (18)

2024 (17)

2023 (12)

2022 (14)

2021 (4)

2020 (11)