Provider Network Negotiation Specialist

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A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

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Provider Network Negotiation Specialist

PRIMARY PURPOSE : To negotiate fee-for-service ancillary contracts for multiple lines of business in managed care markets; to maintain provider participation within the network; and to expand and develop provider network.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Negotiates fee-for-service durable medical equipment and other ancillary services; contracts for multiple lines of business in the managed care markets.

• Analyzes market data and financial models.

• Prepares, negotiates, and administers provider contracts.

• Develops and expands provider participation within the network.

• Maintains provider participation within the network.

• Monitors provider performance; implements corrective action plans.

• Identifies current issues and probable future issues; guides staff through resolution.

• Documents contracts; updates contracts as changes occur.

• Coordinates customer inquiries.

ADDITIONAL FUNCTIONS and RESPONSBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing

Bachelor's degree with major in Health Services or Hospital Administration from an accredited college or university preferred.

Experience

Four (4) years of progressive provider network contract negotiation experience or equivalent combination of education and experience required. Experience in a healthcare management environment including provider contracting, servicing and benefit interpretation preferred. Two (2) years supervisory experience preferred.

Skills & Knowledge

• Strong project management skills

• Excellent negotiation skills

• Excellent oral and written communication, including presentation skills

• PC literate, including Microsoft Office products

• Leadership/management/motivational skills

• Analytical and interpretive skills

• Strong organizational skills

• Ability to work in a team environment

• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental : Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical : Computer keyboarding, travel as required

Auditory/Visual : Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($45,790 - $58,000 ) . A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (~~~)