Job Details

Senior Contract Negotiator - Health Plan

Moda Health , Portland, OR

Job - Health

Close Date: 10/31/2019

Let’s do great things, together

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Moda Health is seeking a Senior Contract Negotiator. The Senior Contract Negotiator negotiates contracts with physicians, hospitals, complementary care providers and ancillary providers; Evaluates and negotiates contracts in compliance with Moda contract templates and reimbursement structure standards; Responsibilities also include establishing and maintaining strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties.

Primary Functions:

Performs contract negotiations for assigned providers to ensure Moda’s medical provider networks achieve objectives for unit cost performance, access and quality
Coordinates financial analysis with Analytics and Underwriting teams, including developing provider reimbursement strategies to achieve business objectives
Recruits new providers to join Moda networks, based on network goals and objectives
Responsible for understanding and managing medical cost issues and initiating appropriate action
Acts as a liaison for internal projects and committees
Establishes and maintains business relationships with assigned providers and works as lead in a team environment to solve complex provider issues.
Performs other duties as assigned by Manager, Medical Provider Contracting

Are you ready to be a betterist?

If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.

Please apply directly here:

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

Required Skills

1. Demonstrated experience in contract negotiation, including provider, facility, physicians and ancillary
2. Strong knowledge of provider reimbursement mechanisms, including Medicare and Medicaid fee schedules, case rates, per diems, and risk models.
3. Strong verbal, written and interpersonal communication skills
4. Strong financial analysis skills
5. Ability to interpret and analyze complex information
6. Strong decision making abilities
7. Proficiency in MS Office Products (Excel, Word, Power Point)
8. Ability to work independently with minimal guidance
9. Accuracy and detail orientation are required with ability to meet deadlines and prioritize work load
10. Ability to work well under pressure: work with frequent interruptions and shifting priorities
11. Ability to travel within the Moda service area
12. Ability to represent Moda at outside meetings, conferences, and events
13. Strong presentation skills
14. Maintain confidentiality

Complete details: