Network Contractor Provider Network Management (PNM)

Role Overview: The primary responsibility of the Network Contractor is contracting providers, the contracting and re-contracting of providers in an established market. Work Arrangements: Remote

• The associate must reside in Louisiana (LA) and attend site visits to provider and in office meetings in Baton Rouge.

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 SMEs 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 collaborate 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.

Education

& Experience: Associate’s degree required. Bachelor's degree preferred. Master's Degree highly preferred. Minimum of 3 years of Account Executive experience. Minimum of 1 year of contract negotiation experience. Skills & Abilities: Understanding of reimbursement methodologies to include Risk or Value Based contracting.

Ability to have difficult conversations. Financial acumen. Proficiency using MS Office Suite. Strong negotiation, persuasion, and conflict-resolution skills. Knowledge of provider network development, network adequacy, and managed care contracting. Ability to interpret contract language, reimbursement terms, fee schedules, and regulatory requirements.

Strong analytical, problem-solving, and decision-making skills. Ability to manage multiple contracting priorities, deadlines, and provider relationships. Effective written and verbal communication skills with the ability to collaborate across legal, operations, claims, credentialing, and provider network teams.