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Job Field: Legal Jobs
Location: Newport Beach, CA
Salary: $Not stated

JOB SUMMARY:

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<tr><td valign="top" width="450"><b>Job Details:* Bachelor''s Degree* * Responsible for finding and developing provider networks which includes physician, ancillary and hospital contracting; assist other team members with contracting needs for their assigned networks.* Performing ongoing network analysis to ensure adequate coverage of providers.* Recruits and contracts with individual providers who meet established selection criteria to assure adequate geographic and specialty coverage.* Negotiates complex contracts with physician, ancillary, and hospital providers for all networks.* Participates in the maintenance of working relationships within the existing network and assists in the recruitment of new providers.* Assists with the review and development of Requests for Proposals (RFPs) from providers whose services match a need for entering into a contract.* Initiates and assists department personnel in resolving contract disputes related to claims inquiry.* Develops and generates appropriate reports on size, magnitude, cost effectiveness and comparative marketability of all networks for internal and external customers.* Analyze language and rate structures.* Work with other departments (Utilization Management and Quality) to ensure an adequate panel of contracted providers to service the network''s membership.* Works closely with Provider Relations Representatives on contract review and provider education.Minimum Requirements:* Bachelors of Arts/Bachelors of Science degree in healthcare administration, business or related field and/or an equivalent combination of education and work experience.* Experience working with providers, health plans, members and vendors.* Must be able to handle a high volume work load and effectively prioritize work to meet changing deadlines.* Must have strong interpersonal communication skills and the ability to interact effectively with providers and with at all levels within the organization.* Must have the ability to independently resolve issues and deal with a variety of concrete variables in multiple situations.* Must be proficient in Microsoft Office applications including Word, Power Point, Excel and Outlook.* At least 5 years experience negotiating provider contracts.* Proven ability to manage and resolve complex provider service issues.* Significant experience (usually 5+ years) exposure to benefits interpretation and provider networking.* Substantive knowledge of managed care policy and direction.* Knowledge of ICD-9 and CPT codes desired.* Strong analytic and problem solving abilities.* Strong communication and negotiation skills.Req Number:311021

KEY REQUIREMENTS:

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Not stated