Healthcare Provider Relations
4 weeks ago
- Target potential providers to establish contractual agreements.
- Thoroughly understand Alivi’s Corporate Playbook and always ensure alignment with the playbook in all day-to-day activities.
- Work directly with strategic leaders of the company to ensure strategic support for expansion efforts and ability to administer contract arrangements with Health Plans/Payers in Medicare, Medicaid and Commercial lines of business.
- Travel to provider offices as needed to secure Specialty Benefit provider contracts.
- Support Alivi’s business development, corporate growth strategy and goals as needed.
- Recruit, negotiate, contract and re-contract with Specialty Benefit providers at all ‘Levels of Service’ to ensure quality, cost effectiveness and their participation in all products.
- Support contracting efforts for new products/risk strategies and help develop new service areas and negotiating with new providers.
- Support in the development of strategic initiatives relating to provider networks, including service area expansions, new payment and incentive methods, risk arrangements and new products.
- Work with provider relations team to develop and maintain a comprehensive provider network (hospitals, physicians, ancillary) that meets CMS access standards and deliver a full range of healthcare services to our members.
- Analyze, plan, and assure provider network adequately meets all CMS access standards across all geographic areas.
- Communicate internally and externally regarding all provider related issues. Participate in key committees throughout the organization.
- Act as a liaison between Alivi and contracted health plans concerning all aspects of Specialty Benefit provider network participation.
- Supports Credentialing Department by assisting with the collection of physician credentials for newly contracted providers.
- Associates Degree preferred.
- 1 to 2 years experience with Specialty Benefit providers and downstream provider contracting.
- Knowledge of provider reimbursement strategies for Managed Care, government products and commercial products.
- Must have a valid driver’s license.
- Must be able to pass DMV record check.
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