• Address: Houston, TX 77204 (map)
• Date Posted: 11/06/09
• Job Type: Full-time

Requirements:
· Knowledge of network development, provider network operations, provider relationship management, reimbursement analysis, contract performance analysis required.
· At least 5 years of progressively responsible positions in negotiation of health services contracting and /or network field operations required. Progressive responsibility and quantifiable results in network development and delivery system negotiations, contract negotiations and development of ancillary provider reimbursement methods for commercial and government payors.


Responsibilities:
· Secure coverage for multiple product lines with a broad spectrum of payor networks consistent with company strategy. Identify and negotiate payor network contracts.
· Identifies, screens and assists in the recruitment of quality payors in a manner consistent with market strategy, utilizing approved contract templates, approved reimbursement methodologies, and applicable regulations. Recruitment may involve mailing, visits, and /or follow-up calls necessary to execute agreement with PPO’s, HMO’s and IPA’s.
· Remains knowledgeable about the changing regulatory environment.
· Work with provider relations to assure smooth transition from contracting to service activities.
· Coordinate with management and analysts to develop analyses that will result in cost effective contracts.
· Coordinate with Project Manager to assure that contracts are loaded accurately and in a timely manner and to avoid negative impact on claims performance due to retro contracts or inaccurate configuration. Initiate and favorably resolve appeals of claims for network and non-network payers.


Please contact Prometheus Healthcare at 301-693-9057

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