Senior Hospital & Ancillary 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 HOSPITAL & ANCILLARY NETWORK CONTRACTOR who can help shape our vision and support our mission. Here is what the position will look like.

• Leads contracting interactions with prospective and existing hospital, facility, and ancillary providers, serves as the primary point of contact for all matters related to contract structure, reimbursement methodology, and contractual requirements.
• Escalates or coordinates with Leadership as appropriate.
• Builds and maintains constructive relationships with prospective and contracted providers to facilitate effective contract negotiations. Provides timely responses to inquiries regarding contract terms, reimbursement provisions, or related requirements.
• Negotiates hospital and ancillary provider agreements, including reimbursement provisions (e.g., percentage of Medicaid, percentage of Medicare, DRG, APC, percentage of charges, per diems case rates, outlier and stop loss provisions, implants, high-cost drugs, etc.), contract language, operational terms, and compliance requirements. Applies advanced negotiation strategies and collaborates with the Director to finalize language or resolve complex issues.
• Maintains expert-level knowledge of facility and ancillary reimbursement methodologies, regulatory requirements, and Colorado Access Marketplace agreement templates and operational processes to ensure that negotiated agreements are financially and legally sound, compliant, and administrable.
• Assesses hospital and ancillary network adequacy in partnership with the Director and Provider Recruitment and Maintenance staff identifying gaps in service coverage, facility type, geography, or capacity, and secures additional facility or ancillary contracts to meet Marketplace regulatory standards and organizational objectives.
• Oversee the full hospital and ancillary contracting lifecycle, including provider identification, contract negotiation, agreement execution, and internal implementation.
• Works closely with internal operational areas (e.g., Provider Network Services, Credentialing, Claims, Compliance) to promote consistent interpretation and execution of contract terms and to respond to and resolve operational or reimbursement questions / issues pertaining to those provisions.
• Engages relevant internal departments prior to proposing or accepting any non-standard agreement provisions.
• Ensures contract terms and updates are communicated to relevant internal departments, enabling accurate configuration, reimbursement setup, and operational readiness.

What you will bring:

Education: Bachelor’s degree in health administration, business administration, communications, finance or a related field preferred or an equivalent combination of education and experience.

Experience: Minimum of three years of experience negotiating contracts with hospitals, facilities and ancillary providers (e.g., acute care hospitals, health systems, ASCs, SNFs, home health agencies, DME, imaging, labs, etc.) required. Four years of progressive, relevant work experience for commercial, Exchange, Medicare and Medicaid lines of business preferred.

Knowledge, Skills, and Abilities: Working knowledge of medical reimbursement methodologies, including but not limited to commercial, Medicare and Medicaid reimbursement methodology, such as DRGs, APCs, percentage of charges, case rates, per diems, Medicaid inpatient/outpatient payment systems, Resource-Based Relative Value System (RBRVS), and Medicaid fee schedules. Basic understanding of managed care contracting, provider reimbursement methods, claims payment operations, facility and ancillary provider types, departments / service categories, and health care delivery systems. Strong negotiation skills, including negotiation strategy, preparation, and execution. Excellent written and verbal communication skills, with the ability to communicate clearly with providers and internal stakeholders at multiple levels. Strong attention to detail with the ability to manage, prioritize, and execute multiple tasks and projects simultaneously. Ability to organize, refine, and clearly communicate contract language proposals during active negotiations.  Working knowledge of, or willingness to learn, hospital, facility and ancillary market dynamics in Colorado, including ownership (private vs state-funded), consolidation trends, contracting norms, and applicable facility regulations. Ability to work independently, prioritize tasks, and manage large projects to completion while exercising sound judgment around pacing, escalation, and collaboration with the Director of Provider Contracting and cross-functional teams. Demonstrates support for the company’s mission, vision and values.  Position requires excellent written and verbal communication skills. Must be proficient in Microsoft office applications (Word, Excel, PowerPoint, Outlook, SharePoint) with ability to work with a variety of project management tools.  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 - $127,100.00 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.