AT AETNA, WE ARE COMMITTED TO HELPING PEOPLE ON THEIR PATH TO BETTER HEALTH. BY TAKING A TOTAL AND CONNECTED APPROACH TO HEALTH, WE GUIDE AND SUPPORT OUR MEMBERS SO THEY CAN GET MORE OUT OF LIFE, EVERY DAY. WE ARE LOOKING FOR PEOPLE LIKE YOU WHO VALUE EXCELLENCE, INTEGRITY, CARING AND INNOVATION. AS AN EMPLOYEE, YOU’LL JOIN A TEAM DEDICATED TO IMPROVING THE LIVES OF TEXAS MEMBERS. WE VALUE DIVERSITY AND ARE DEDICATED TO HELPING YOU ACHIEVE YOUR CAREER GOALS.

In this Aetna Network Management Role individual contributor role the contract negotiator:

• Negotiates competitive contracts with health care providers using pre-determined internal guidelines and financial standards.
• Negotiates contract language in accordance with Aetna standards, engaging other departments as needed for review and approval of contract terms outside the standards.
• Conducts competitive and financial analyses to achieve best in market discounts and financial results that are within pre-determined targets.
• Manages contract performance and works with various internal departments to address questions, issues, and activities related to execution, loading, and ongoing maintenance of provider contracts.
• Negotiates and supports the implementation of value-based contract relationships in support of business strategies.
• Manages relationships with key providers and ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
• Negotiates settlements as needed. May recruit providers as needed to ensure network adequacy and achievement of network expansion goals. Maintains accountability for specific medical cost initiatives.
• Candidates residing in Texas Preferred; however, not required.

REQUIRED QUALIFICATIONS

• 3+ years of experience negotiating contracts with ancillary providers, physician groups, and IPAs, including contract language, development, and analysis of rate proposals, identifying operational and financial improvement opportunities, and collection and analysis of competitive data and key financial metrics. Uses competitive and financial data, as well as analysis detail, to negotiate favorable contracts.
• 3+ years of working knowledge of complex contracting options, provider reimbursement methodologies and terms, and contract setup. Understanding of provider financial issues, industry standard payment policies, regulatory requirements, and competitor strategies.
• Must be proficient in Word, Excel, and Microsoft Office.

PREFERRED QUALIFICATIONS

• Professional and Ancillary contracting experience.
• Strong critical thinking, problem resolution, organization, communication, and interpersonal skills.
• Able to successfully manage multiple negotiations, issues, and other tasks to ensure completion and meet deadlines.
• Able to manage expectations and maintain strong relationships, both internally and externally.
• Experience negotiating and/or managing value-based contracts brings added value.

EDUCATION

• Bachelor’s Degree or equivalent combination of education and professional work experience.

• Negotiates competitive contracts with health care providers using pre-determined internal guidelines and financial standards.
• Negotiates contract language in accordance with Aetna standards, engaging other departments as needed for review and approval of contract terms outside the standards.
• Conducts competitive and financial analyses to achieve best in market discounts and financial results that are within pre-determined targets.
• Manages contract performance and works with various internal departments to address questions, issues, and activities related to execution, loading, and ongoing maintenance of provider contracts.
• Negotiates and supports the implementation of value-based contract relationships in support of business strategies.
• Manages relationships with key providers and ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
• Negotiates settlements as needed. May recruit providers as needed to ensure network adequacy and achievement of network expansion goals. Maintains accountability for specific medical cost initiatives.
• Candidates residing in Texas Preferred; however, not required