Network Contract Specialist
Responsible for loading, implementation, maintenance of standard provider contracts, schedules and agreements and files in support of business segment contracting initiatives.
Design, develop, contract, maintain and enhance relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for members; foster growth of managed care products; and enhance profitability of Aetna.
Builds, loads and maintains standard contracts, agreements, amendments and/or fee schedules, tables in contract management systems. Ensure that signature and delegation activities are complete per required timeframes.
Partners with internal constituents and provides information to ensure contract compliance adherence to company policies and procedures including contracting guidelines, clinical and payment policy information, coding requirements, and other required policies/procedures. Sends, receives, processes and documents and triages provider contracts and agreements and ensures all paperwork is received, complete and accurate. Sends agreement to providers. Partners cross-functionally to ensure credentialing process is complete. Requests appropriate analyses (financial, legal, business language reviews) as appropriate. Maintains contract and agreement files and file management systems and spreadsheets and is single point of contact for questions related to same as well as special projects, internal audit, core, provider service organization and other functional areas for contract copies and information.
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills with proven ability to influence and collaborate with providers and partners at all levels.
Contract interpretation skills
1-2 years' experience with business segment specific policy, benefits, plan design and language.
Working knowledge of internal contracting systems and processes
4+ years' experience in business segment specific environment servicing or managing non-standard relationships with providers with exposure to benefit plan design and/or contract interpretation.
3-5 years' experience with business segment specific policy, benefits, plan design and language.
Working knowledge of business segment specific codes, products, and terminology.
Associate's degree or equivalent work experience.
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