Job description
Company Overview:
The Enlyte Family of Businesses
Mitchell | Genex | Coventry
Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.
Job Description:
- Design, develop, contract, maintain and enhance relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for claimants; foster growth of products; and enhance profitability of Coventry.
- Negotiates, executes, reviews, and analyzes contracts with large hospital/facilities (i.e. hospitals, large groups/systems, ancillaries) in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, compliance, quality, financial goals, cost initiatives, and client satisfaction.
- Manages contract performance in support of network quality, availability, and financial goals and strategies.
- Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
- Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
- Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives.
- Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit.
- Assists with the design, development, management, and or implementation of strategic network configurations, including integration activities.
- May optimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met.
- Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
- Bachelor's degree preferred
- Proven working knowledge of competitor strategies, complex contracting options, value based contracting, financial/contracting arrangements.
- 5+ years related experience, proven and proficient negotiating skills.
- Strong communication, critical thinking, problem resolution and interpersonal skills.
- Microsoft Office experience
- Customer service oriented mindset.
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