Provider Contracting Consultant

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more – in our careers and in our communities.

Job Description Summary:

Responsible to be a major contributor for the development and managements of the provider network through contract negotiations, relationship development and maintenance. Assists in analysis of network needs regarding services and specialties across the health plan’s geographic footprint, with regard to program(s) and client(s’) needs for adequacy. Responsible for successfully negotiating provider agreements with reimbursement in keeping with the health plan’s financial competitiveness.

Responsibilities And Duties:

25%      Provider target analysis, identification and contacting                        
30%      Provider Agreement negotiation, and amendment writing                
15%      Provider issue, problem, &/or concern investigation and resolution
10%      Provider communication development and distribution      
10%      Provider reporting internal, and to providers (value base programs         
10%      Misc.

Minimum Qualifications:

Bachelor's Degree

Additional Job Description:

• Degree, or equivalent 5 years of work experience and responsibility. 

SPECIALIZED KNOWLEDGE

• Knowledge of healthcare provider contracts, operations in billing, claims submission, payment/reimbursement mechanisms & methodologies, health plan benefits designs (commercial, Medicaid & Medicare), and referral/authorization processes.
• Understanding of credentialing process and policies.
• Understanding NCQA Accreditation elements, policies and procedures for successful audit,
• Computer skill, expertise and experience with MicroSoft Word, Excel, Powerpoint, and data bases.
• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, contracts or governmental regulations.
• Ability to write provider agreement amendments, reports, newsletters, business correspondence, and procedure manuals.
• Ability to effectively present information and respond to questions both internally (within the health plan) and externally, with groups of managers, clients, customers, and the general public. 
• Ability to negotiate successfully to meet or exceed health plan goals and objectives, regarding provider costs and provider network adequacy

RESPONSIBILITIES AND DUTIES

25%      Provider target analysis, identification and contacting                        
30%      Provider Agreement negotiation, and amendment writing                

15%      Provider issue, problem, &/or concern investigation and resolution

10%      Provider communication development and distribution      

10%      Provider reporting internal, and to providers (value base programs         

10%      Misc.

Work Shift:

Day

Scheduled Weekly Hours :

40

Department

Ohiohealthy

Join us!
... if your passion is to work in a caring environment
... if you believe that learning is a life-long process
... if you strive for excellence and want to be among the best in the healthcare industry

Equal Employment Opportunity

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment