Job Description:
Evaluate, negotiate and recommend necessary
changes to existing contracts to ensure that
targeted provider performance and financial goals
are met.
Plays a key role, as part of the team, working on
and supporting special risk programs such as the
Share Savings program as well as other risk
programs.
Identify medical cost improvement opportunities,
the development of contracting action plans and
facilitation of regular meetings with appropriate
provider representatives to achieve results.
Manage the delivery of financial settlements and
the collection of receivables.
Act as a liaison to partners and providers to
ensure understanding of company policies,
administrative procedures and practices.
Act as a resource and provide training, as
required, to ensure staff has the resources to
meet performance goals and objectives, develop
and implement feedback mechanisms to
determine satisfaction levels relative to
administrative support, service, communications
and reimbursement.
Work, in conjunction with Provider Relations, to
ensure that the company addresses Provider’s
issues and concerns.
Initiate changes and recommendations for
solutions to improve ongoing compliance and
ensure reimbursement strategies and other
objectives are met in future contract periods
