Job Summary:

The Health Partner Contracting Specialist II focuses on building and maintaining provider partnerships that optimize network access, availability, and financial outcomes.

Essential Functions:

• Identify, evaluate, and onboard healthcare providers to expand the CareSource provider network.
• Collaborate with providers to negotiate favorable terms and conditions for contracts. Ensure agreements are in alignment with CareSource goals and regulatory compliance.
• Maintain a comprehensive understanding of provider specialties and geographic coverage to enhance network adequacy.
• Review and target specialties or areas that do not meet adequacy standards. Provide updates on progress to leadership.
• Cultivate positive relationships with providers and health systems, addressing concerns and fostering open communication.
• Act as a liaison to facilitate issue resolution and maintain a cohesive provider network.
• Organize and conduct educational sessions for providers to enhance their knowledge and understanding of CareSource processes outlined in the contract and provider manual.
• Identify agreement or reimbursement discrepancies and facilitate resolution with the appropriate stakeholders.
• Develop and manage documentation of provider contracts that deviate from standards and require non-standard operational support or payment methodologies.
• Present new non-standard contract terms to the Contract Review Committee
• Collaborate with Payment Cycle to ensure agreement templates are reflective of provider contract terms and reimbursement requirements.
• Manage contract disputes and conflicts, working to find equitable solutions.
• Partner with internal teams such as legal, finance, operations, and compliance to ensure Network initiatives align with company goals.
• Perform any other job-related instructions as requested.

Education and Experience:

• Bachelor degree in business or related field or equivalent years of relevant work experience is required
• Minimum of three (3) years of data management and analysis, contracting, administrative, or related experience is required

Competencies, Knowledge and Skills:

• Proficient in MS Word, PowerPoint and advanced skills in Excel
• Ability to learn new software applications
• Analytical abilities to identify discrepancies and downstream implications to provider reimbursement
• Ability to organize and manage complex data sets
• Strong written communication and editing skills
• Knowledgeable of provider contracts and compensation requirements
• Ability to multi-task and juggle competing priorities
• Effective communication (verbal and written)
• Project coordination or equivalent organizational skills
• Attention to detail
• Ability to work independently and within a team environment
• Strong interpersonal skills and high level of professionalism
• Critical listening and thinking skills
• Technical writing skills
• Time management skills

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:
$60,300.00 - $96,500.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Create an Inclusive Environment - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.