Job Description

ELAP PROVIDES A COMPREHENSIVE, REFERENCE BASED PRICING SOLUTION THAT HELPS SELF-FUNDED EMPLOYERS ACROSS THE US SIGNIFICANTLY REDUCE THEIR HEALTHCARE COSTS.

WITH DOUBLE DIGIT INCREMENTAL GROWTH,WE ARE GUIDED BY AN ENTREPRENEURIAL CULTURE THAT REWARDS INNOVATION AND TEAMWORK. WE FOSTER THE FREE FLOW OF IDEAS AND VALUE INITIATIVE, TRUST, CREATIVITY AND PASSION - QUALITIES WE CONSIDER ESSENTIAL TO OUR SUCCESS. THERE ARE MANY REASONS WHY IT'S GOOD TO BE AN ELAP EMPLOYEE; AND ONE OF THEM IS OUR GENEROUS, 100% PAID (FOR EMPLOYEES / 60% FOR DEPENDENTS) COMPREHENSIVE BENEFITS PROGRAM THAT HELPS YOU AND YOUR FAMILY STAY HEALTHY, FEEL SAFE AND MAINTAIN BALANCE WORK / LIFE. ANOTHER IS OUR EXCEPTIONAL 401K MATCH, IN WHICH YOU ARE VESTED 100% IMMEDIATELY. TO LEARN MORE, APPLY TODAY!

ELAP'S VALUES

• WE LEVEL THE PLAYING FIELD
• WE PASSIONATELY CHALLENGE THE STATUS QUO
• WE INNOVATE
• WE ADVOCATE
• WE EMPOWER CLIENTS AND FAMILIES
• WE ARE ACCOUNTABLE

SUMMARY

This position is responsible for physician and other healthcare service providers contracting, day-to-day support of the provider networks as assigned and for performing ongoing network analysis for all contracts pertaining to network development and management needs. The primary function is recruiting and contracting with individual providers who meet established selection criteria.

This position will also play a critical part in helping ensure that all inbound provider-related issues for the assigned market networks are addressed and resolved in a timely fashion. This crucial role directly impacts the experience of the members, providers and third-party administrators that use our core product.

Reporting to the Director of Contracting, this role requires an entrepreneurial approach to negotiating physician contracts to help the growth and success of new networks in targeted markets.

DUTIES AND RESPONSIBILITIES

• Assess, recruit and organize provider contract needs for PPO networks and other critical provider partnerships.
• Negotiate complex contracts with physician and other healthcare provider contacts.
• Assist with legal review and interpretation with regard to the financial and legal impact of provider contract language as requested.
• Develop and generate appropriate reports on size, magnitude, cost effectiveness and comparative marketability of all networks for internal and external customers.
• Conduct rate and contract negotiations with all assigned contracting entities in collaboration with company leaders.
• Work in partnership with corporate leaders ensuring contracting and other collateral information meets the needs of contracting elements.
• Assist with market analysis for development projects.
• Support new start activity and identify other potential business opportunities to support core growth.
• Work closely with the operations and customer success teams to ensure our clients and TPA partners are adhering to our provider contracts and policies.
• Attend provider meetings and team meetings either locally or with travel occasionally, and as needed.

EDUCATION AND EXPERIENCE

• Bachelors Degree required
• Minimum 3 years' experience as a Provider Representative in the managed care, benefits, or health insurance industry required.
• 2 years' experience recruiting new providers into a new or established network.
• 2 years' experience negotiating new, complex contracts with providers preferred.
• Substantive knowledge of managed care industry including compliance.

SKILLS AND ABILITIES

• Must be familiar with healthcare pricing and reimbursement technologies, including solid knowledge of ICD-9, MSDRG and CPT Codes.
• Strong written, verbal and presentation communication skills and effective relationship management experience a must.
• Attention to detail; ability to juggle multiple priorities and deadlines; strong follow through.
• Ability to work independently as well as within a team support environment.
• Willingness to take on projects outside of normal scope of existing job description for the greater good of the team
• Must possess strong analytical and problem-solving skills
• Proficient in the MS Office Suite to include MS Word, Excel, PowerPoint and Outlook