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Overview

Work Shift

AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Sr. Contract Negotiator. This position is 100% remote however traveling to our Doral office in Miami, FL will be required as needed.

Scope of position:The Senior Contract Negotiator will exhibit the highest level of professionalism, be service driven, detail oriented, proactive in training and messaging and possess excellent communication skills, as well as exemplary planning to help AvMed achieve and maintain market leadership. Their goal for assigned practices will be to demonstrate high quality and cost-effective delivery of medical services to AvMed members, while maintaining high membership and satisfaction. The Senior Contract Negotiator will take ownership of their assigned territory, be recognized as an outstanding leader and subject matter expert for their assigned territory.

Essential Job Functions:

• Maintains a cost-effective Physician network in assigned geographic territories as measured by, financial targets, quality indicators, provider and member satisfaction, and the market's success in increasing profitable market share.
• Maintains a thorough operational knowledge of contractual agreements and specific contractual language between AvMed and assigned physicians.
• Ensures that there are the appropriate number and location of primary providers to meet accessibility standards and marketing needs.
• Negotiates and implement varied reimbursement methodologies, including full risk and fee for service.
• Creates and implements an annual recruitment plan and contracting strategy, working in tandem with the Manager, Director and Vice President of Network to identify and select quality, cost effective providers.
• Responsible for the relationship management of MSO's and providers in assigned territory including addressing issues related to operational problems and provider satisfaction.
• Develops comprehensive, provider specific plans to improve physician engagement and performance related to patient satisfaction, quality measures, and risk scores, identifying educational needs and opportunities.
• Coordinates and delivers provider education, coaching, and training related to STARS measures (HEDIS/CAHPS/HOS), AvMed's policies, tools, reports, and systems.
• Coordinates with Provider Data Contract Management and other pertinent departments to ensure all contractual language is configured correctly for accurate claims adjudication; and ensures pre-testing for selected, more complex physician agreements.
• Maintains and applies a comprehensive understanding of reimbursement methodologies, including pay-for-performance, value-based and risk agreements, and the appropriate application of each.
• Assists in the coordination and follow up of JOC meetings with provider groups to drive continual process improvement and achieve goals.
• Serves as an AvMed representative in the general and professional community.
• Performs additional duties and responsibilities as assigned by management.

Minimum Requirements:

• Bachelor's in business administration or healthcare related field required
• Master's preferred
• 4 plus years of healthcare contract negotiation experience, with direct contact with physicians/facilities and office staff
• Experience with the servicing of provider contracts including but not limited to updates to provider demographics, loading of contracts, and resolving claims issues

Preferred Requirements:

• Knowledge of the relevant marketplace, its provider networks, and managed care dynamics
• Strong knowledge of medical claims, CPT coding and billing practices
• Extensive knowledge of claims processing, procedures, and system capabilities
• Excellent verbal and written communication skills
• Strong analytical skills and financial analysis experience including experience with Excel, Word, and PowerPoint
• Demonstrates strong negotiating and influencing skills that are organized and constructed for successful outcomes, is well planned and prepared for, and is centered around "win-win" solutions

Our Benefits:

As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:

• Medical, Dental, and Vision Insurance
• Paid Annual Leave, Sick Leave
• Flexible Spending Accounts
• Retirement funds with matching contribution
• Supplemental insurance policies, including legal, Life Insurance and AD&D among others
• Work Perks program including discounted movie and theme park tickets among other great deals
• Opportunities for further advancement within our organization

Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For information about our employee benefits, please visit: Benefits - Sentara (sentaracareers.com)

Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!

Note: Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability, and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.

Keywords: Talroo-Health Plans, #INDEED, Contract Negotiation

Job Summary

Qualifications:

Skills

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission "to improve health every day," this is a tobacco-free environment.