Job Details

ID #3358874
State Texas
City Conroe
Full-time
Salary USD TBD TBD
Source Aetna
Showed 2020-02-07
Date 2020-02-07
Deadline 2020-04-07
Category Et cetera
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TX STAR+PLUS Contract Negotiator

Texas, Conroe 00000 Conroe USA

Vacancy expired!

Req ID: 68380BRJob DescriptionAt Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you ll join a team dedicated to improving the lives of Texas STAR+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.Negotiates, executes, conducts review and analysis, dispute resolution and/or settlement negotiations of contracts with group/system providers in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality, and financial goals and cost initiatives. Participates in specific medical cost initiatives. Travel is required with personal vehicle. Must have active and valid TX driver's license, reliable transportation and vehicle insurance. Routine travel to Houston office and other locations, per business needs.

HARRIS SERVICE AREA: Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller and Wharton counties.

Fundamental Components included but are not limited to:Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers. Manages contract performance in support of network quality, availability, and financial goals and strategies. Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities. Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit. Assists with the design, development, management, and or implementation of strategic network configurations, including integration activities. May optimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.Qualifications Requirements and Preferences:

Proven working knowledge of competitor strategies, complex contracting options, value based contracting, financial/contracting arrangements and regulatory requirements.

3-5 years related experience, proven and proficient negotiating skills.

Strong communication, critical thinking, problem resolution and interpersonal skills.

Bachelor s Degree or equivalent combination of education and experience.

Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.

Functional Skills:Network Management - Contract negotiationTechnology Experience:Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft ExcelRequired Skills:Benefits Management - Interacting with Medical Professionals, General Business - Communicating for Impact, Sales - Managing Competitive NetworksDesired Skills:General Business - Communicating for Impact, Sales - Managing Competitive Networks, Sales - Negotiating CollaborativelyAdditional Job Information:

Travel to the Dallas office may be required for onboarding, training and meetings.

At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you ll join a team dedicated to improving the lives of Texas STAR+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.Benefit EligibilityBenefit eligibility may vary by position.Job Function: HealthcareAetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

Vacancy expired!

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