Healthcare Contracting Specialist at Provider… · Location…

Job Type Full-time Description Position Summary Manages physician contracting and network development functions for developing, executing and maintaining a provider network strategy statewide. Works in concert with medical management and the Provider Servicing Department in developing actions to meet market growth and medical cost targets. Duties and Responsibilities • Primary duty of negotiating and executing provider contracts. • Leads research for any Institution, Network and/or Ancillary needs using all tools available; including but not limited to: WebMD, Health Plan websites, hospitals, google, etc. • Provider networks contracting for initial network development and/or expansion in accordance with Company goals and standards. • Meet with the appropriate physician personnel and fully explain the Company’s protocol, which includes all requirements necessary to comply with standards identified in the Provider Manual. • Collects complete credentialing packets per specified health plan and according to the Networks Credentialing checklist from network physicians during the contracting process. • Ensures that the provider network consists of Board Certified/Board Eligible Specialists and/or Ancillary providers as contracted by the network. • Manages physician network by developing relationships to drive business results within assigned geographic area. • Liaison in conjunction with Contracting and Credentialing Coordinator, for all health plans on all new contracting inquiries. • Obtains leads for prospective physicians, manages all incoming new provider leads and follows-up with the providers on the status of their new contractual agreement per the Department’s Policies and Procedures. • Strategizes to close all quarterly assigned Geo Access deficiencies per specialty and health plan. • Special projects as assigned or directed. • Negotiating and executing hospital contracts. • Maintaining and updating current CRM platform (Monday.com) to reflect progress of ongoing leads negotiations. Requirements Knowledge • A bachelor’s degree in a related field or equivalent experience related Network Development or Provider Relations experience. • Minimum three (3) years’ experience in Medicaid/Medicare is preferred. • Healthcare, provider office or HMO/PPO background preferred. • Strong knowledge of regulatory requirements concerning Medicare and Medicaid. Skills • Excellent problem-solving skills. • Excellent oral and written communication skills. • Bilingual language skills a plus. • Intermediate or stronger skill level with MS Word, Excel, Outlook and PowerPoint. Travel Yes, 95% of the time or as otherwise required by the company. Region 6: Hardee, Highlands, Hillsborough, Manatee and Polk Region 8: Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota Salary Description $60,000.00 - $63,000.00 per year