Job Summary

Manages day to day relationships with the Health Plan partners and providers. Performs provider recruitment, contracting and relationship management. Coordinates the implementation of and all lifecycle activities of a partnership and/or relationship. Responds to complex inquiries, solving non-routine problems and ensuring partner and/or provider satisfaction. Acts as a technical resource regarding policies, procedures, workflows, complex partner/provider issues and training needs.

Job Duties

• Develops, negotiates and renegotiates contractual and financial arrangements with physician, ancillary and institutional providers.
• Collaborates internally with departments such as Sales, QI, Medical Management, Customer Service and claims to align strategic relationships accordingly.
• Participates in the development of business objectives for provider relationships.
• Leads and participates in development activities throughout both new and existing markets, including tracking and reporting of recruitment activities, progress and barriers to a successful, on-time go live.
• Develops and executes provider specific strategies, goals and objectives including specialty-specific pay for quality programs and strategy for implementation.
• Supports ongoing strategic assessment of provider network.
• Ensures all contracts are negotiated in compliance with regulatory requirements and follow all required policies and procedures related to contract negotiation and implementation.
• Leads the creation, implementation and ongoing improvements of negotiation tools reports and analytics.
• Coordinates and communicates contractual terms to other departments whose functions are necessary to the development, implementation and management of the provider arrangements and relationships.
• Provides service-related functions necessary to identify and resolve service inquiries from participating provider network and other healthcare professionals.
• Documents a detailed account of all provider contacts in the applicable database established and maintained by staff.
• Accurately records and updates provider information necessary for the ongoing function of various operational departments.
• Prepares customized orientation programs to educate participating providers regarding policy and procedure, reimbursement methodology, financial terms and concepts, product lines and associated benefit structure.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

If a suitably experienced candidate cannot be found, applicants who meet the basic qualifications but possess fewer years of experience will be considered for hire at a lower level. Salary would commensurate with experience.

Position Details

Education

High School Diploma or Equivalent (GED)- (Required), Bachelor's Degree- (Preferred)

Experience

Minimum of 5 years-Relevant experience* (Required)

Certification(s) and License(s)

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.