Job Description
Manages and negotiates the development and implementation of professional, ancillary and facility contracts for the Northwell Direct provider network. Addresses operational and contractual issues and ensures contract rates and contract terms are implemented and maintained in accordance with contractual obligations.
Job Responsibility
- Devises new methods and procedures using strong analytic and inductive thinking
- Works with senior executives to develop and drive system-wide functional strategies, as well as external strategies
- Advises one or more areas, programs or functions and provides recommendations to senior executives on matters of significance
- Negotiates and problem solves conflicts with operational and third party issues
- Regularly makes decisions under minimal guidance that have significant impact on financial and business operations
- Works both independently and collaboratively at the most advanced level across multiple areas
- Partners with providers to collaborate on contracts
- Manages physician recruitment and acts as a physician liaison
- Involved with rate negotiations and analytics
- Provides guidance to operational team members from basic to complex tasks and projects
- As a subject matter expert, works at high levels in multiple knowledge and functional areas across and outside of the system
- Majority of contact is within our own function or area; will collaborate with other professionals outside of own function and outside of the system
- Serves as project/technical lead on small to medium sized projects
- Skilled with broad, advanced provider and/or contractor experience
Job Qualification
- Bachelors Degree or Masters Degree, equivalent combination of education and related experience
- All licensures and certifications needed for function and level, if any
- Minimum Prior Technical Experience = 10+ years
- Minimum Leadership/Management Experience = 2+ years
Job Preferences:
- Experience as a primary point of contact for provider inquiries regarding claims, policies, benefits, and network participation preferred.
- Familiarity with operational onboarding from contracting to the orientation process for newly contracted providers.
- Knowledge of provider data management, credentialing, contract loading and provider directory processes.
- Experience collaborating with both internal and external partners to investigate, troubleshoot, and resolve provider disputes, claim issues, and payment grievances.
- Understanding of medical terminology, health insurance claims and coding (ICD-10, CPT, DRG), and payer systems.
- Basic understanding of provider contracting.
- Additional Salary Detail
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team members base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).