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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in provider network contracting and reimbursement analysis, with a strong understanding of regulatory requirements and health care products. Capable of effective communication and problem-solving while maintaining compliance with legislative mandates.
Highest-signal resume keywords
Provider Network ReimbursementProvider ContractingFinancial AnalysisContractual Language InterpretationHealth Care Administration
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Provider Reimbursement MethodologiesData AnalysisModelingContract PreparationBudget Management
Soft Skills
Verbal CommunicationWritten CommunicationProblem-SolvingStakeholder EngagementNegotiation
Industry Keywords
Health Care ComplianceLegislative MandatesMedical Care DeliveryMarket DynamicsProvider Network Administration
About the role
Key responsibilities & impact- Establishes and maintains network adequacy for assigned provider types, regions and/or lines of business
- Serves as provider network contracting and administration subject matter expert for assigned areas
- Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies
- Identifies, investigates, and analyzes issues and questions; collects and interprets data and information to support provider network contracting and administration activities
- Applies contract terms, regulatory and legal requirements, and other information to produce accurate and actionable analysis
- Prepares and presents information, findings, and recommendations to internal and external stakeholders
- Serves as liaison with assigned stakeholders to identify and coordinate provider network contract and administration work items
- Executes initiatives; tracks, forecasts and reports on progress including qualitative and quantitative measures
- Engages in provider contract negotiations with providers, clinical, and operational leadership
- Assists in preparing provider contracts, amendments, and communications
- Maintains knowledge of relevant legislative and regulatory mandates to ensure compliance
- Responds to and resolves inquiries from providers and colleagues
- Leads issue resolution with internal and external stakeholders
- Supports the Lifetime Healthcare Companies’ mission and values, Corporate Code of Conduct, and Lifetime Way values and beliefs
- Maintains member privacy in accordance with corporate privacy policies and procedures
- Maintains regular and reliable attendance
- Performs other functions as assigned by management
Requirements
What you’ll need- Six (6) years of provider network reimbursement or related experience required, or a Bachelor’s degree in Health Care Administration or relevant field
- Two (2) years of experience directly performing provider contracting or reimbursement analysis required
- Demonstrated experience of provider reimbursement methodologies
- Ability to draft, interpret and apply contractual language
- Technical skills including modeling and financial analysis
- Understanding of medical care delivery, industry trends, and regional market dynamics
- Strong, persuasive, and effective verbal and written communication skills
- Knowledge of health care products and services offered to members
- Excellent problem-solving skills
- Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time
- Ability to travel across the Health Plan service region for meetings and/or trainings as needed
Benefits
Comp & perks- Group health and/or dental insurance
- Retirement plan
- Wellness program
- Paid time away from work
- Paid holidays
- Opportunity for remote work, determined on a case-by-case basis