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Provider Contracting Negotiator



* Responsible for management of hospital and physician contracts, including contract negotiations and ongoing management of contracting issues.


* Leads negotiations with network providers, including responsibility for the end to end management of provider negotiations and ongoing contract management.


* In conjunction with leadership, develops negotiation strategies based on assessment of baseline analytics, financial targets, contractual terms, IBC strategic objectives and industry trends.


* Ensures provider contracting is consistent with claim payment methodologies.


* Accountable for ongoing management of an assigned contract portfolio including assessment and resolution of issues, contract performance monitoring unit-cost budgeting, ongoing provider engagement and incentive plan performance.


* Ensures that non-standard contract elements are communicated to appropriate departments and obtains AMFC and Plan approval prior to submission to provider.


* Ensures that contract requirements are communicated timely and accurately to operational areas throughout term of each contract. 


* Works closely with network services team to ensure servicing issues are being resolved in accordance with contractual terms.


* Coordinates with internal stakeholders (e.g.

Care Management, Legal, Operations) to ensure contract terms are administered correctly and issues are incorporated into negotiation objectives.


* Communicates negotiation status to Director and senior leadership throughout process.


* Assists in the development of FHN strategies, reimbursement methodologies and processes.


* Builds and maintains positive relationships with counterparts in the Provider community.


* Performs other duties as assigned.

Education/Experience:



* Bachelor’s degree in business or health related discipline such as Healthcare Administration or Healthcare Management .

Master’s Degree preferred.


* Minimum of 5 years hospital contracting/reimbursement experience in healthcare setting.




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