Contract Negotiation Manager
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Job Description
Contract Negotiation Manager negotiating provider agreements and settlements for CVS Health. Managing network quality, adequacy, reimbursement, and cost initiatives across Pennsylvania and neighboring states.
Responsibilities:
- Negotiate, execute, review, and analyze contracts with solo, small-group, or local providers
- Handle provider dispute resolution and settlement negotiations
- Manage contract performance in support of network quality, availability, financial goals, and strategies
- Recruit providers to support network expansion and adequacy targets
- Collaborate on provider compensation, pricing development, contractual information, negotiation, and reimbursement modeling activities
- Identify and recommend solutions for cost issues and support cost-saving initiatives and settlement activities
- Perform network development, maintenance, and refinement activities
- Assist with strategic network configuration and integration activities
- Optimize interactions with assigned providers and internal business partners
- Resolve escalated issues involving claims payment, contract interpretation, contract parameters, and provider contract or demographic information
Requirements:
- A minimum of 5 years of experience negotiating contracts with ancillary providers, facilities, and physician groups
- Experience with contract language, development and analysis of rate proposals, identifying operational and financial improvement opportunities, and collection and analysis of competitive data and key financial metrics
- 3+ years of experience in provider relationship management or related healthcare roles
- Proficient contract management skills
- Understanding of common contract provisions, provider reimbursement methodologies and terms, and industry standard payment policies and practices
- Understanding of provider financial issues, regulatory requirements, and competitor strategies
- High proficiency with Microsoft Office suite applications, including Outlook, Word, and Excel
- Ability to build collaborative relationships with providers and work cross-functionally to resolve complex provider contract issues
- Ability to manage and prioritize multiple negotiations, issues, and tasks to meet deadlines
- Experience with Commercial and Medicare lines of business preferred
- Bachelor's degree preferred or a combination of professional work experience and education
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility
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