Job Description
Description
:JOB SUMMARY
This job is responsible for directing negotiation of the plan’s key contracts with health care providers (hospitals, PHOs, physicians, intermediate care providers). Directs financial analyses of the provider’s payment history, develops approaches to manage the payout consistent with company parameters, oversees the actual negotiation process, and assumes the lead where necessary. Responsible for the development, implementation, maintenance, and updating of the plan’s multiple fee schedules and payment methodologies used to reimburse institutional and professional providers. Implements network contract and reimbursement initiatives as indicated by enterprise and market strategy.
ESSENTIAL RESPONSIBILITIES