Our Network Development Payment Negotiator is responsible for assisting with the management of controlling and reducing costs for offsite medical care. The payment negotiator will align with TPA and ensure CCS has access to the best providers at the lowest cost in locations where needed.
- Bachelor’s degree in related field or equivalent experience.
- At least five (5) years of Managed Care/Healthcare contracting experience with five (5) or more years of experience working with Managed Care contract terms and reimbursement methods.
- Position requires strong skills in MS WORD, EXCEL, PowerPoint, and Outlook.
- Excellent analytical, leadership, communication and presentation skills.
- None required
- Develops and continually reduces costs within the CCS provider network.
- Conducts contract language and rate negotiations with hospital, facility, ancillary, and professional providers to ensure network development goals are met. Recommends market fee schedules and rate targets that are competitive and within CCS contract requirements.
- Maintains a working knowledge of industry, national healthcare reform, national coding initiatives, licensure and accreditation, payer benefit packages, policies and procedures, and interprets this information to contracted providers.
- Develops and continually optimizes the CCS private provider network for out-of-facility healthcare services to minimize cost and maximize patient access.
- Through both in-house referrals and data analysis identifies network gaps or optimization opportunities.
- The above responsibilities are a highlight of responsibilities and not a full list. Other responsibilities may be performed as assigned.