The Senior Provider Contracting & Relations Manager contributes to The Alliance’s goal of helping employers better manage their healthcare costs while remaining transparent and emphasizing value by developing and maintaining The Alliance’s provider network in designated markets. This is a hybrid position.
Responsibilities:
- Visits prospective and existing providers to negotiate provider contracts that meet performance objectives.
- Builds and maintains effective provider partnerships by serving as the primary point of contact for managed providers for matters related to the interpretation and administration of the provider contract.
- Develops, manages, and implements strategic initiatives that advance department goals and objectives.
- Leads complex projects relative to value-based payment methodologies, total cost of care, and performance metrics, ensuring timelines and objectives are met.
- Coordinates efforts with Business Development and may conduct employer presentations related to The Alliance provider network.
- Stays abreast of industry and product/plan initiatives, including Advanced Primary Care products, reimbursement, value-based methodologies, coding, and contracting trends relative to providers, and continually recommends initiatives that advance The Alliance toward goals and objectives that further the mission of improving healthcare value.
- Reviews and assesses The Alliance employers’ needs and develops and implements strategic contracting plans to fulfill network initiatives.
- Gathers market intelligence and information through community, employer, broker, and provider relationships to recommend and assist with implementing initiatives that improve The Alliance’s value proposition with employers.
Qualifications:
- Bachelor’s degree or an equivalent combination of education and experience.
- At least seven years experience working in the healthcare or insurance industry in provider relations and contracting, establishing working relationships with providers of healthcare services.
- Extensive knowledge of different types of reimbursement methodology, including Medicare-based contracting, capitation, total cost of care, etc.
- Familiarity with hospital organizational structures.
- This position has extensive experience and knowledge of value-based payment methodologies, including total cost of care and performance metrics.
- Strong written and verbal communication skills, including the ability to present to large and small groups.
- Experience writing legal contracts.
- Strong negotiating experience.
- Experience with financial pro formas and modeling to create reimbursement methodologies that benefit employers.
- Ability to develop strong relationships with employers.
- Proficiency with Microsoft products, including Word, Excel, and database software.
- Familiarity with Wisconsin health care systems and geography.
- Ability to travel regionally.
The Organization
As a not-for-profit cooperative, The Alliance is employer-owned and remains a trusted, objective partner for employers and their brokers who seek improved access to high-quality healthcare.
We’re Madison-based, but we work with 340+ employers across the Midwest and contract with over 38,000 doctors and other healthcare providers in the region. Our goal is to help employers better manage their healthcare costs while remaining transparent and emphasizing value – creating healthier, more engaged workforces.
The Alliance is celebrating over 30 years as a mission-driven and member-focused collective with experienced leadership and strong organizational departments backed by top talent. By joining The Alliance team you’ll become part of a passionate, collaborative, and supportive organization: one that fosters meaningful connections and relationships with high levels of employee engagement and satisfaction.
Diversity, Equity, and Inclusion (DEI) are critical for The Alliance to realize Our Vision and attract, retain, and excite exceptional people. The Alliance is committed to embedding DEI into our culture such that diverse experiences and perspectives are valued and welcomed, driving innovative solutions for our employer members, employees, and their families.
Our health plan is self-funded, which means we share the same interests and use the same tools we offer our clients. We lead by example because when we take care of our employees, they take care of our clients (and their employees).
We set our employees up for success, encouraging their professional advancement and personal growth. We offer a competitive compensation and benefits package, including health/dental/vision/life insurance, a generous Staff Incentive Bonus program, 401(k), and annual Continuing Education and Wellness benefits.
