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CarePlus Health Plans · 2 days ago

Provider Contracting Network Rep

Ohio, United States

Full-time

Hybrid

Entry, Mid Level

$65K/yr - $89K/yr

2+ years exp

CarePlus Health Plans is a recognized leader in healthcare delivery, focusing on Medicare Advantage health plans. The Provider Contracting Professional 2 role involves negotiating and executing contracts with healthcare providers to ensure compliance with regulatory and business requirements while maintaining strong relationships with key providers.

Health CareHealth InsuranceWellness

Responsibilities

Actively communicates contract terms, payment structures, reimbursement rates to providers internal and external constituents

Negotiating and maintaining contracts with hospital partners to ensure our network meets regulatory and business requirements

Managing relationships with key providers to support member access, minimize disruption, and maintain competitive advantage

Ensuring contract terms are implemented accurately and that our organization is protected from risk, both financially and legally

Supporting cross-functional teams with timely updates on contracting status, rate changes, and network developments

Managing these contract relationships with large statewide hospital systems requires the team to work with internal and external constituents on all areas of contracting; network management; adequacy and gaps; provider education; conflict resolution; claim escalation and research; compliance initiatives and grievances; joint operating committees; and all other facets of the business while also working closely with our Humana counterparts on enterprise initiatives

Qualification

Negotiating managed care contractsAnalyzing financial impactPublic speakingACO/Risk ContractingValue Based ContractingMS Office proficiencyManaging multiple prioritiesWritten communicationVerbal communication