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Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.


 

At True Health New Mexico, a Bright HealthCare company, we focus on improving the health and well-being of our health plan members by making sure their healthcare is coordinated at every level. Our model of care prioritizes and facilitates “well-care,” not “sick-care.” We strive to improve members’ health while lowering their healthcare costs and helping them become an active participant in their own care. Our benefit plans, programs, and services help our members reach their best state of health and reduce unnecessary, high-cost care such as emergency room visits and hospitalizations. As a physician-led health plan, our top priority is connecting our members to the care they need to help them achieve and maintain their highest health status. We serve individuals, small and large businesses, and federal employees across New Mexico. Join the True Health New Mexico team and put your passion to work transforming the healthcare and health insurance landscape.

The Network Contracting Specialist works closely with internal and external customers and is the main point of contact for provider contracting and re-contracting activities. The Network Contracting Specialist works with the support of the Director of Provider Services to negotiate non-standard provider contracts.

ROLE RESPONSIBILITIES

1. Responds to Letters of Interest
2. Creates and distributes standard provider and facility contracts
3. Coordinates activities to implement standard provider and facility contracts
4. Responds to requests to renegotiate existing contracts
5. Coordinates implementation of renegotiated contracts
6. Prepares contract summaries for the Director of Provider Services for any contract or amendment that deviates from the standard contract language and reimbursement
7. Works with the Director of Provider Services, or under the direction of the Director, to negotiate and recommend changes to the standard contract or amendment and reimbursement based on providers’ requests
8. Works closely with the Medical Management team and Director of Provider Services to negotiate and implement single case agreements
9. Serves as the main point of contact for out of network providers

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
• Bachelor’s Degree or relevant experience
• At least 2-years of experience working with managed care contract terms and reimbursement methodologies.
• At least 2-years of experience using financial modeling to make reimbursement decisions.

PROFESSIONAL COMPETENCIES
• Advanced PC skills, particularly with Microsoft Word and Excel
• Excellent written and oral communication and presentation skills
• Ability to interpret contractual language
• Negotiation skills

WORK ENVIRONMENT
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required.

 

We’re Making Healthcare Right. Together.

We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
 
Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
 
Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
 
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
 
          

 
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 

 

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