Provider Recruiting and Contracting Analyst

2 days ago

Minneapolis MN United States Fulcrum Health, Inc. Full time

ORGANIZATION

Fulcrum Health, Inc. is a nonprofit, physical medicine benefit management organization that has delivered quality care through its network of over 4,800 credentialed physical medicine service providers for over 40 years. Our product offerings include acupuncture, chiropractic, massage therapy, physical, speech and occupational therapy services, serving over 2 million health plan members. Fulcrum continues to offer innovative and inspiring ways to leverage physical medicine that help lower health care costs, achieve better outcomes, and increase patient satisfaction.

POSITION PURPOSE

The Fulcrum Health, Inc. (Fulcrum) Provider Recruiting and Contracting Analyst will recruit providers to ensure the attainment of network expansion and adequacy targets. The Network Development Analyst will develop collaborative working relationships with providers and serve as a liaison between provider and Fulcrum to ensure provider service needs are met.

ACCOUNTABILITIES:

  • Conduct outreach to potential providers.
  • Establish and maintain solid business relationships with providers and ensure the network composition includes an appropriate distribution of provider specialties.
  • Identify and gather information regarding provider issues to develop and/or implement strategy to resolve matters, keep manager informed of progress, or escalate issue to appropriate internal business partner.
  • Represent department in external meetings (e.g., recruitment functions at schools /association events or provider meetings) to gather relevant information, recommend solutions, execute on deliverables as assigned and explain results/decision/activities.
  • Collaborate with utilization review to monitor and educate providers on quality performance, identifying opportunities to improve performance and/or provider relationships.
  • Initiate, create, and execute provider contracts/agreements on behalf of health plan organizations.
  • Communicate contract terms, payment structure, and reimbursement rates to providers.
  • Maintain contracts and documentation within a tracking system.
  • Assist with identifying and recruiting providers based on network composition and needs.
  • Advise the organization on matters of moderate to significant contractual complexity.
  • Assist in drafting internal and external-facing communications on complex topics that may require extensive amounts of research.
  • Implement process improvements, mitigate contractual and financial risks while creating efficiencies.
  • Performs other duties as assigned.

KEY WORK ATTRIBUTES:

  • Develops innovative approaches.
  • Anticipates customer needs and proactively develops solutions to meet them.
  • Ability to adapt quickly as a high growth less mature business contributes to a dynamic, fluid, high learning work environment.
  • Passionate about contributing to an organization focused on continuously improving consumer experiences.
  • Works independently on many projects with minimal supervision.
  • Demonstrates understanding of contracting look-up tools and reports.
  • Show understanding of contract language to assess financial and operational impact and legal implications of requested contract changes.
  • Demonstrates understanding of competitor landscape within the market (e.g., rates; market share; products; provider networks; market intelligence; GeoAccess).
  • Demonstrates ability to utilize appropriate contract management systems (e.g., Symplr- Cactus, Power BI, Documed) to author and execute contracts and to access supplemental contractual documents.
  • Proficiency in analyzing, understanding, and communicating contract terms, payment structures and reimbursement rates to providers.
  • Motivates and inspires other team members.

REQUIRED QUALIFICATIONS: (Minimum qualifications needed for this position)

  • Bachelor's degree in business, contracting, legal, communications, or related field.
  • 3+ years of experience in healthcare contracting or equivalent experience in healthcare setting.
  • Excellent communication, writing, and presentation skills.
  • Ability to think creatively and strategically.
  • Ability to manage multiple priorities in a fast-paced environment.
  • Excellent attention to detail.
  • Strong analytical and problem-solving skills.
  • Proficient with Microsoft Office Suite.

DIRECT/INDIRECT REPORTS:

Number of direct reports and titles: 0

Number of indirect reports: 0

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