Senior Provider Network Contractor

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford.  Our mission is to partner with communities and empower people through access to quality, affordable care.

Why should you consider a career with Colorado Access?

We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion.

1. Find work/life balance:  We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.
2. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference.
3. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

What you will do:

We are looking for a SENIOR PROVIDER NETWORK CONTRACTOR who can help shape our vision and support our mission. Here is what the position will look like.

• Negotiates complex provider agreements utilizing a variety of negotiation strategies and techniques with all provider types, with emphasis on developing strategic partnerships with facilities, health systems, integrated care delivery systems, physician hospital organizations, independent practice associations, individual providers and clinics, ancillary providers, FQHCs and other providers. .
• Maintains proficiency in current and proposed reimbursement methodologies for facility and professional contracts, contract language and provisions and organizational operations to assure contract offers can be implemented and effectively administered.
• Provides comprehensive management of the contracting process, including rate and language negotiations, and operational implementation.
• Works with contracted providers on contract interpretation and assists with operational and/or reimbursement issue resolution.
• Serves as the project lead and subject matter expert for one or more of the following:
  • Development and revision of multiple contract templates for contract management system, in collaboration with the Director, and software vendor 
  • Fee schedule analysis
  • Appropriate billing and coding for physical and behavioral health
  • Serves as contract management system administrator as assigned
  • Works with legal and other staff to resolve complex claims issues
• Provides financial and operational performance analysis of existing and pending Provider contracts.
• Provides guidance, support and direction to Managed Care Contractors and other department staff as needed.
• Participates in Lines of Business financial operational meetings as assigned by Director.

What you will bring:

Education: Bachelor’s degree in health administration, business administration or related field required with a Masters’ degree preferred. Any combination of education or experience may be substituted for education or experience.

Experience:  Five to eight years’ experience negotiating complex contracts with health care providers (e.g., hospitals, health systems, medical groups, clinics). Experience with strategic planning; development, revision and quality control of contract templates, contracting guidelines; determination of network adequacy and capacity standards and other policies and procedures.

Knowledge, Skills, and Abilities:  Working knowledge of the various medical reimbursement platforms including the Resource Based Relative Value System,   Diagnostic Related Groups, and Medicaid reimbursement required. Demonstrates support for the company’s mission, vision and values.  Must have excellent negotiation skills and techniques and knowledge of current negotiation strategies.  Position requires excellent written, verbal and public speaking communication skills.  Requires training, project development and management skills. Advanced knowledge of managed care contracting, provider reimbursement and claims payment, medical terminology, and health care delivery systems required. Knowledge of local health and community agencies and providers preferred.  Strong attention to detail with ability to handle multiple tasks simultaneously required. Ability to deal with multiple levels of staff. Must be able to handle high volume workload. Ability to work independently with little direction and initiate work priorities.  Must be proficient in MS-Office applications (Word, Excel, and Access).  May be required to manage multiple priorities and projects with tight deadlines. 

Licenses/Certifications:  A valid driver's license and proof of current auto insurance will be required for any position requiring driving.   

Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization.

Pay, Perks and Benefits at Colorado Access:

The compensation for this position is $105,900.00 to $120,000.00 annually. Colorado Access has provided a compensation range that represents its good faith estimate of what Colorado Access may pay for the position at the time of posting. Colorado Access may ultimately pay more or less than the posted compensation range. The salary offered to the selected candidate will be determined based on factors such as the qualifications of the selected candidate, departmental budget availability, internal salary equity considerations, and available market information, but not based on a candidate’s sex or any other protected status.

In addition to being part of a mission driven organization serving our community, as an eligible Colorado Access employee, you’ll receive a generous benefits package, that includes:

• Medical, dental, vision insurance that starts the first day of the month following start date. 
• Supplemental insurance such as critical illness and accidental injury. 
• Health care and dependent care flexible spending account options.
• Employer-paid basic life insurance and AD&D (employee, spouse and dependent). 
• Short-term and long-term disability coverage.
• Voluntary life insurance (employee, spouse, dependent).
• Paid time off
• Retirement plan
• Tuition reimbursement (based on eligibility). 
• Annual bonus program (based on eligibility, requirements and performance).

Where you will work:

This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’ 

We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of Colorado.

Colorado Access is committed to providing equal opportunities to all people regardless of race, color, national origin, age, sex, genetic information, religion, pregnancy, disability, sexual orientation, veteran status or any other status protected by applicable law. We strive to maintain a work environment that is free from unlawful harassment and discrimination.