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Aetna Provider Contract Negotiator in Omaha, Nebraska

Req ID: 67844BR

Job Description

Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with providers (i.e. individual providers/physicians, groups/systems, hospitals) in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals and cost initiatives.

** Must reside in Omaha, NE OR Bismarck, ND

Fundamental Components included but are not limited to:

  • Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, group, or facility 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:

  • Knowledge of provider contracting REQUIRED

  • 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 contract negotiating skills.

  • Knowledge of Medicare payment methodologies is a plus

  • Strong understanding of data analysis & financials

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

  • Bachelor s Degree or equivalent combination of education and experience.

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Healthcare

Aetna 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.